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NPI Code Detail

MEDICARE: PAIN MANAGEMENT ASSOCIATES LLC

MEDICARE: PAIN MANAGEMENT ASSOCIATES LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207LP2900XPain Medicine (Anesthesiology) PhysicianME0054730FL

General Provider Information

NPI Number : 1093862062
Entity Type Code : Organization
Provider Name (Legal Business Name) : PAIN MANAGEMENT ASSOCIATES LLC
Provider Business Mailing Address
First Line : PO BOX 864164
Second Line :
City : ORLANDO
State : FL
Zip : 32886-4164
Country : US
Telephone Number : 352-867-8898
Fax Number : 352-732-6282
Provider Business Practice Location Address
First Line : 2400 DUNDEE RD
Second Line :
City : WINTER HAVEN
State : FL
Zip : 33884-1166
Country : US
Telephone Number : 352-867-8898
Fax Number : 352-732-6282
Authorized Official
Title or Position : MANAGING MBR
Name : JORGE R VILLARREAL
Credential : MD
Telephone Number : 863-299-1231
Provider Enumeration Date : 01/04/2007
Last Update Date : 08/22/2020

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Directions to “PAIN MANAGEMENT ASSOCIATES LLC ” Practice Location

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