Provider Demographics
NPI:1285665851
Name:WEST FLORIDA PAIN MANAGEMENT PA
Entity Type:Organization
Organization Name:WEST FLORIDA PAIN MANAGEMENT PA
Other - Org Name:MINIMALLY INVASIVE SPINE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-317-5603
Mailing Address - Street 1:PO BOX 919017
Mailing Address - Street 2:LOCK BOX 9017
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-9017
Mailing Address - Country:US
Mailing Address - Phone:727-553-7313
Mailing Address - Fax:727-553-7320
Practice Address - Street 1:603 7TH ST S STE 320
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701
Practice Address - Country:US
Practice Address - Phone:727-553-7313
Practice Address - Fax:727-553-7320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK0997OtherPTAN
FL1284000004Medicare NSC