MEDICARE: KETI MEDICAL CENTER & PAIN MANAGEMENT INC

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

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	:	1205979291
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KETI MEDICAL CENTER & PAIN MANAGEMENT INC

Provider Business Mailing Address
First Line	:	7105 MARINER BLVD
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34609-1048
Country	:	US
Telephone Number	:	352-596-1339
Fax Number	:	352-596-8772

Provider Business Practice Location Address
First Line	:	7105 MARINER BLVD
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34609-1048
Country	:	US
Telephone Number	:	352-596-1339
Fax Number	:	352-596-8772

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SHYAM S SWAIN
Credential	:	MD
Telephone Number	:	352-596-1339

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	08/11/2023

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