MEDICARE: HOPE PAIN MANAGEMENT GROUP, LLC.

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	HCC8512	FL

General Provider Information

NPI Number	:	1700015682
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOPE PAIN MANAGEMENT GROUP, LLC.

Provider Business Mailing Address
First Line	:	1250 MARINER BLVD
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34609-5657
Country	:	US
Telephone Number	:	352-688-4673
Fax Number	:	352-684-4673

Provider Business Practice Location Address
First Line	:	1250 MARINER BLVD
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34609-5657
Country	:	US
Telephone Number	:	352-688-4673
Fax Number	:	352-684-4673

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	MISS DIANNA L. SEIJAS
Credential	:
Telephone Number	:	352-688-4673

Provider Enumeration Date	:	07/13/2009
Last Update Date	:	07/13/2009

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