Provider Demographics
NPI:1114114303
Name:JACKSONVILLE PAIN CENTER PA
Entity Type:Organization
Organization Name:JACKSONVILLE PAIN CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HEMANT
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-268-8200
Mailing Address - Street 1:PO BOX 600290
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32260-0290
Mailing Address - Country:US
Mailing Address - Phone:904-268-8200
Mailing Address - Fax:
Practice Address - Street 1:9421 WAYPOINT PL
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-9229
Practice Address - Country:US
Practice Address - Phone:904-268-8200
Practice Address - Fax:904-268-8298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95262208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty