MEDICARE: BEHAVIORAL PAIN SPECIALISTS LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207LP2900X	Pain Medicine (Anesthesiology) Physician
2	261QH0100X	Health Service Clinic/Center
3	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1134975881
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEHAVIORAL PAIN SPECIALISTS LLC

Provider Business Mailing Address
First Line	:	3005 W EUCLID AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-8954
Country	:	US
Telephone Number	:	813-508-1859
Fax Number	:	888-850-1859

Provider Business Practice Location Address
First Line	:	3005 W EUCLID AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-8954
Country	:	US
Telephone Number	:	813-508-1859
Fax Number	:	888-850-1859

Authorized Official
Title or Position	:	PRESIDENT AND CEO
Name	:	BOBBY L COATES
Credential	:	MDIV, LPC,LMFT LMHC
Telephone Number	:	813-508-1859

Provider Enumeration Date	:	04/24/2024
Last Update Date	:	04/24/2024

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