1225358450 NPI number — NEURO-PAIN MEDICAL CENTER

Table of content: (NPI 1225358450)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225358450 NPI number — NEURO-PAIN MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEURO-PAIN MEDICAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NEURO-PAIN MEDICAL CENTER
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225358450
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13248 TELECOM DR.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEMPLE TERRACE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33637
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-971-7272
Provider Business Mailing Address Fax Number:
813-971-6063

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13248 TELECOM DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEMPLE TERRACE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33637-0932
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-971-7272
Provider Business Practice Location Address Fax Number:
813-971-6063
Provider Enumeration Date:
06/10/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JULIUS
Authorized Official First Name:
WALE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
813-971-7272

Provider Taxonomy Codes

  • Taxonomy code: 302R00000X , with the licence number:  PMC 845 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)