Provider Demographics
NPI:1346436995
Name:GULF COAST PAIN MANAGEMENT PA
Entity Type:Organization
Organization Name:GULF COAST PAIN MANAGEMENT PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:C
Authorized Official - Last Name:COLUMBUS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:727-789-0891
Mailing Address - Street 1:3001 EASTLAND BLVD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-4104
Mailing Address - Country:US
Mailing Address - Phone:727-789-0891
Mailing Address - Fax:727-789-1570
Practice Address - Street 1:3001 EASTLAND BLVD
Practice Address - Street 2:SUITE 7
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-4104
Practice Address - Country:US
Practice Address - Phone:727-789-0891
Practice Address - Fax:727-789-1570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6713207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL050067680OtherRAILROAD MEDICARE
FL6649710001Medicare NSC
FLK8189Medicare PIN