Provider Demographics
NPI:1558488452
Name:ALLIANCE MEDICAL PAIN MANAGEMENT L L C
Entity Type:Organization
Organization Name:ALLIANCE MEDICAL PAIN MANAGEMENT L L C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARISSA
Authorized Official - Middle Name:H
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-877-6191
Mailing Address - Street 1:10213 LAKE CARROLL WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-4405
Mailing Address - Country:US
Mailing Address - Phone:813-877-6191
Mailing Address - Fax:813-877-6195
Practice Address - Street 1:10213 LAKE CARROLL WAY
Practice Address - Street 2:SUITE A
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-4405
Practice Address - Country:US
Practice Address - Phone:813-877-6191
Practice Address - Fax:813-877-6195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL27936YOtherBCBS
FLK4572Medicare PIN
FL27936YOtherBCBS