Provider Demographics
NPI:1417105008
Name:MUA PAIN MANAGEMENT CENTER OF ORALANDO, LLC
Entity Type:Organization
Organization Name:MUA PAIN MANAGEMENT CENTER OF ORALANDO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:NOBACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-756-1051
Mailing Address - Street 1:132 BENMORE DR
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-4101
Mailing Address - Country:US
Mailing Address - Phone:407-756-1051
Mailing Address - Fax:
Practice Address - Street 1:132 BENMORE DR
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-4101
Practice Address - Country:US
Practice Address - Phone:407-756-1051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center