MEDICARE: PAIN MANAGEMENT AND RELIEF

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1760706212
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAIN MANAGEMENT AND RELIEF

Provider Business Mailing Address
First Line	:	7819 N DALE MABRY HWY STE 206
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-3221
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7819 N DALE MABRY HWY STE 206
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-3221
Country	:	US
Telephone Number	:	813-374-8953
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	GREGORY RODRIGUEZ
Credential	:
Telephone Number	:	813-374-8951

Provider Enumeration Date	:	03/25/2010
Last Update Date	:	03/25/2010

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