Provider Demographics
NPI:1194195784
Name:NATURAL MEDICINE AND PAIN CENTER LLC
Entity Type:Organization
Organization Name:NATURAL MEDICINE AND PAIN CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALAINA
Authorized Official - Middle Name:
Authorized Official - Last Name:EDGEMON
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:813-996-4773
Mailing Address - Street 1:123 S WIGGINS RD
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33566-7351
Mailing Address - Country:US
Mailing Address - Phone:813-996-4773
Mailing Address - Fax:
Practice Address - Street 1:1215 W BAKER ST
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-4309
Practice Address - Country:US
Practice Address - Phone:813-996-4773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-25
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3660171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty