Provider Demographics
NPI:1013025162
Name:PAIN CENTER OF CENTRAL FL PA
Entity Type:Organization
Organization Name:PAIN CENTER OF CENTRAL FL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:AVERY
Authorized Official - Last Name:MELVIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:407-649-7800
Mailing Address - Street 1:3861 OAKWATER CIR STE 2
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-6258
Mailing Address - Country:US
Mailing Address - Phone:407-649-7800
Mailing Address - Fax:407-649-9881
Practice Address - Street 1:3861 OAKWATER CIR STE 2
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-6258
Practice Address - Country:US
Practice Address - Phone:407-649-7800
Practice Address - Fax:407-649-9881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0055539207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL09101OtherBCBS
FL1669423001OtherCIGNA PPO
FL208633OtherAVMED
FL1669423007OtherCIGNA HMO
FL45385Medicare PIN
FL1669423007OtherCIGNA HMO