MEDICARE: BROOKSVILLE PAIN MANAGEMENT, INC.

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	261QP3300X	Pain Clinic/Center	ME0067353	FL

General Provider Information

NPI Number	:	1700976578
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROOKSVILLE PAIN MANAGEMENT, INC.

Provider Business Mailing Address
First Line	:	5467 COMMERCIAL WAY
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34606-1110
Country	:	US
Telephone Number	:	352-597-7111
Fax Number	:	352-597-7171

Provider Business Practice Location Address
First Line	:	5467 COMMERCIAL WAY
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34606-1110
Country	:	US
Telephone Number	:	352-597-7111
Fax Number	:	352-597-7171

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHAEL DOYLE COURTNEY
Credential	:	M.D.
Telephone Number	:	352-597-7111

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	08/09/2010

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