Provider Demographics
NPI:1558553180
Name:PAIN & WELLNESS INSTITUTE PA
Entity Type:Organization
Organization Name:PAIN & WELLNESS INSTITUTE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DEVANG
Authorized Official - Middle Name:M
Authorized Official - Last Name:PADALIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-873-7777
Mailing Address - Street 1:4509 N ARMENIA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-2703
Mailing Address - Country:US
Mailing Address - Phone:813-873-7777
Mailing Address - Fax:813-873-7776
Practice Address - Street 1:4509 N ARMENIA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-2703
Practice Address - Country:US
Practice Address - Phone:813-873-7777
Practice Address - Fax:813-873-7776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-17
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87139207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL920729585816Medicare Oscar/Certification