MEDICARE: NATURAL MEDICINE AND PAIN CENTER 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
1	171100000X	Acupuncturist	AP3660	FL

General Provider Information

NPI Number	:	1194195784
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATURAL MEDICINE AND PAIN CENTER LLC

Provider Business Mailing Address
First Line	:	123 S WIGGINS RD
Second Line	:
City	:	PLANT CITY
State	:	FL
Zip	:	33566-7351
Country	:	US
Telephone Number	:	813-996-4773
Fax Number	:

Provider Business Practice Location Address
First Line	:	1215 W BAKER ST
Second Line	:
City	:	PLANT CITY
State	:	FL
Zip	:	33563-4309
Country	:	US
Telephone Number	:	813-996-4773
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ALAINA EDGEMON
Credential	:	AP
Telephone Number	:	813-996-4773

Provider Enumeration Date	:	09/25/2015
Last Update Date	:	09/25/2015

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