MEDICARE: JACKSONVILLE PAIN CENTER PA

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
1	208VP0014X	Interventional Pain Medicine Physician	ME95262	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114114303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACKSONVILLE PAIN CENTER PA

Provider Business Mailing Address
First Line	:	PO BOX 600290
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32260-0290
Country	:	US
Telephone Number	:	904-268-8200
Fax Number	:

Provider Business Practice Location Address
First Line	:	9421 WAYPOINT PL
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-9229
Country	:	US
Telephone Number	:	904-268-8200
Fax Number	:	904-268-8298

Authorized Official
Title or Position	:	PRESIDENT/ OWNER
Name	:	DR. HEMANT SHAH
Credential	:	M.D.
Telephone Number	:	904-268-8200

Provider Enumeration Date	:	10/01/2007
Last Update Date	:	12/21/2010

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Directions to “JACKSONVILLE PAIN CENTER PA ” Practice Location

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