MEDICARE: SURGICAL PAIN CONSULTANTS OF FLORIDA PLLC

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	ME 115987	FL

General Provider Information

NPI Number	:	1487053492
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURGICAL PAIN CONSULTANTS OF FLORIDA PLLC

Provider Business Mailing Address
First Line	:	10740 N CENTRAL EXPY STE 275
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-2166
Country	:	US
Telephone Number	:	214-378-4661
Fax Number	:	888-624-8659

Provider Business Practice Location Address
First Line	:	3185 MARINERS WAY
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32963-9423
Country	:	US
Telephone Number	:	214-378-4661
Fax Number	:	888-624-8659

Authorized Official
Title or Position	:	CREDENTIALLING COORDINATOR
Name	:	BRANDY BARROW
Credential	:
Telephone Number	:	214-378-4661

Provider Enumeration Date	:	08/14/2014
Last Update Date	:	08/14/2014

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