Provider Demographics
NPI:1639464191
Name:SARASOTA PAIN MANAGEMENT, INC.
Entity Type:Organization
Organization Name:SARASOTA PAIN MANAGEMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSTD
Authorized Official - Prefix:MR
Authorized Official - First Name:COURTLAND
Authorized Official - Middle Name:
Authorized Official - Last Name:TWYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-921-3500
Mailing Address - Street 1:PO BOX 53067
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-0326
Mailing Address - Country:US
Mailing Address - Phone:941-921-3500
Mailing Address - Fax:941-921-3300
Practice Address - Street 1:5580 BEE RIDGE RD
Practice Address - Street 2:BUILDING B
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-1505
Practice Address - Country:US
Practice Address - Phone:941-921-3500
Practice Address - Fax:941-921-3300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-13
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLC9311208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty