Provider Demographics
NPI:1710682539
Name:PRIME INTERVENTIONAL CONSULTANTS CORP
Entity Type:Organization
Organization Name:PRIME INTERVENTIONAL CONSULTANTS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PATTANAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SRINIVASAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-891-0721
Mailing Address - Street 1:2189 CLEVELAND ST STE 211
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-3213
Mailing Address - Country:US
Mailing Address - Phone:727-469-3733
Mailing Address - Fax:
Practice Address - Street 1:2189 CLEVELAND ST STE 211
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-3213
Practice Address - Country:US
Practice Address - Phone:727-469-3733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty