MEDICARE: PAIN MEDICINE SPECIALISTS 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	208VP0014X	Interventional Pain Medicine Physician	ME0032630	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00231386	OTHER		RR MEDICARE NUMBER

General Provider Information

NPI Number	:	1922114875
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAIN MEDICINE SPECIALISTS INC

Provider Business Mailing Address
First Line	:	111 N LAKEMONT AVE
Second Line	:	SUITE 2E
City	:	WINTER PARK
State	:	FL
Zip	:	32792-3217
Country	:	US
Telephone Number	:	407-628-5838
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 N LAKEMONT AVE
Second Line	:	SUITE 2E
City	:	WINTER PARK
State	:	FL
Zip	:	32792-3217
Country	:	US
Telephone Number	:	407-628-5838
Fax Number	:

Authorized Official
Title or Position	:	CEO/MEDICAL DIRECTOR
Name	:	ANTONIO CERTO
Credential	:	M.D.
Telephone Number	:	407-628-5838

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	08/22/2020

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Directions to “PAIN MEDICINE SPECIALISTS INC ” Practice Location

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