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General NPI Number Information
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NPI Number | 1962552299
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Entity Type | Organization
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Legal Business Name | TAMPA PAIN RELIEF CENTER, INC.
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 05/06/2019
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Provider Practice Location Address
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Address Line | 2333 W HILLSBOROUGH AVE STE 100
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City | TAMPA
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State | FL
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Zip | 33603-1052
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Country | US
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Telephone | 813-569-6500
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Fax |
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Provider Business Mailing Address
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Address Line | 4919 MEMORIAL HWY STE 200
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City | TAMPA
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State | FL
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Zip | 33634-7500
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Country | US
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Telephone | 813-569-6500
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Fax |
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Authorized Official
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Title or Position | OFFICER AND AUTHORIZED OFFICIAL
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Name | JENNIFER BOYD BALDOCK
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Credential |
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Telephone | 615-234-5900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number | ME0054890
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License Number State | FL
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