MEDICARE: PR MEDICAL CENTER PLC

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	208VP0000X	Pain Medicine Physician	PMC207	FL

General Provider Information

NPI Number	:	1295032209
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PR MEDICAL CENTER PLC

Provider Business Mailing Address
First Line	:	10750 N 56TH ST
Second Line	:
City	:	TEMPLE TERRACE
State	:	FL
Zip	:	33617-3615
Country	:	US
Telephone Number	:	813-988-1500
Fax Number	:

Provider Business Practice Location Address
First Line	:	10750 N 56TH ST
Second Line	:
City	:	TEMPLE TERRACE
State	:	FL
Zip	:	33617-3615
Country	:	US
Telephone Number	:	813-988-1500
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ELSHAFEY ABDALLAH-ASHOUR
Credential	:
Telephone Number	:	813-988-1500

Provider Enumeration Date	:	02/28/2011
Last Update Date	:	02/28/2011

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Directions to “PR MEDICAL CENTER PLC ” Practice Location

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