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NPI Code Detail

MEDICARE: ADVANCED PAIN CLINIC PA

MEDICARE: ADVANCED PAIN CLINIC PA
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
1207LP2900XPain Medicine (Anesthesiology) PhysicianME0066759FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1972770428
Entity Type Code : Organization
Provider Name (Legal Business Name) : ADVANCED PAIN CLINIC PA
Provider Business Mailing Address
First Line : 505 W VINE ST
Second Line : 301
City : KISSIMMEE
State : FL
Zip : 34741-4123
Country : US
Telephone Number : 407-935-9404
Fax Number :
Provider Business Practice Location Address
First Line : 82 MAXCY PLAZA CIR
Second Line :
City : HAINES CITY
State : FL
Zip : 33844-2488
Country : US
Telephone Number : 407-935-9404
Fax Number :
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : DR. VRAJLAL L RAJYAGURU
Credential : MD
Telephone Number : 407-935-9404
Provider Enumeration Date : 05/14/2008
Last Update Date : 05/14/2008

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Directions to “ADVANCED PAIN CLINIC PA ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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