MEDICARE: ORLANDO PAIN CENTERS OF EXCELLENCE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207L00000X	Anesthesiology Physician
2	208VP0014X	Interventional Pain Medicine Physician
3	207T00000X	Neurological Surgery Physician

General Provider Information

NPI Number	:	1659031326
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORLANDO PAIN CENTERS OF EXCELLENCE LLC

Provider Business Mailing Address
First Line	:	515 W STATE ROAD 434 STE 201
Second Line	:
City	:	LONGWOOD
State	:	FL
Zip	:	32750-5162
Country	:	US
Telephone Number	:	407-745-1115
Fax Number	:	407-745-1005

Provider Business Practice Location Address
First Line	:	515 W STATE ROAD 434 STE 201
Second Line	:
City	:	LONGWOOD
State	:	FL
Zip	:	32750-5162
Country	:	US
Telephone Number	:	407-745-1115
Fax Number	:	407-745-1005

Authorized Official
Title or Position	:	MD
Name	:	JOHN GERNERT
Credential	:
Telephone Number	:	423-381-5699

Provider Enumeration Date	:	12/22/2021
Last Update Date	:	12/22/2021

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