MEDICARE: PAIN TREATMENT CENTER OF FLORIDA, 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	174400000X	Specialist

General Provider Information

NPI Number	:	1891078861
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAIN TREATMENT CENTER OF FLORIDA, INC

Provider Business Mailing Address
First Line	:	PO BOX 1005
Second Line	:
City	:	LUTZ
State	:	FL
Zip	:	33548-1005
Country	:	US
Telephone Number	:	813-731-0416
Fax Number	:

Provider Business Practice Location Address
First Line	:	4106 HENDERSON BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-5750
Country	:	US
Telephone Number	:	813-731-0416
Fax Number	:

Authorized Official
Title or Position	:	GENERAL PARTNER
Name	:	DR. GEORGE S. SIDHOM
Credential	:	MD
Telephone Number	:	813-731-0416

Provider Enumeration Date	:	09/26/2011
Last Update Date	:	09/26/2011

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