MEDICARE: TAMPA PAIN RELIEF CENTER

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	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician
2	207LP2900X	Pain Medicine (Anesthesiology) 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	:	1639359474
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAMPA PAIN RELIEF CENTER

Provider Business Mailing Address
First Line	:	5501 W GRAY ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-1007
Country	:	US
Telephone Number	:	813-569-6500
Fax Number	:	813-569-6262

Provider Business Practice Location Address
First Line	:	8583 W LINEBAUGH AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33625-3731
Country	:	US
Telephone Number	:	813-872-4492
Fax Number	:	813-870-1502

Authorized Official
Title or Position	:	PAYOR RELATIONS DIRECTOR
Name	:	MS. NANCY J CASTELLANA
Credential	:
Telephone Number	:	813-569-6500

Provider Enumeration Date	:	11/09/2007
Last Update Date	:	11/09/2007

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