MEDICARE: TAMPA PAIN CLINIC 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	208VP0000X	Pain Medicine Physician	ME58829	FL

General Provider Information

NPI Number	:	1750399200
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAMPA PAIN CLINIC LLC

Provider Business Mailing Address
First Line	:	3500 E FLETCHER AVE
Second Line	:	ROOM 204
City	:	TAMPA
State	:	FL
Zip	:	33613-4708
Country	:	US
Telephone Number	:	813-769-5629
Fax Number	:	813-978-8797

Provider Business Practice Location Address
First Line	:	3500 E FLETCHER AVE
Second Line	:	ROOM 204
City	:	TAMPA
State	:	FL
Zip	:	33613-4708
Country	:	US
Telephone Number	:	813-769-5629
Fax Number	:	813-978-8797

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID VANDERCAR
Credential	:	MD
Telephone Number	:	813-769-5629

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	07/27/2007

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Directions to “TAMPA PAIN CLINIC LLC ” Practice Location

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