Provider Demographics
NPI:1629371000
Name:TAMPA PAIN RELIEF CENTER
Entity Type:Organization
Organization Name:TAMPA PAIN RELIEF CENTER
Other - Org Name:LAKE MARY PAIN RELIEF CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-569-6500
Mailing Address - Street 1:325 WAYMONT CT
Mailing Address - Street 2:111
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3572
Mailing Address - Country:US
Mailing Address - Phone:813-872-4492
Mailing Address - Fax:
Practice Address - Street 1:325 WAYMONT CT
Practice Address - Street 2:111
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3572
Practice Address - Country:US
Practice Address - Phone:813-872-4492
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty