Provider Demographics
NPI:1710929211
Name:SPINAL DISORDERS AND PAIN TREATMENT INSTITUTE
Entity Type:Organization
Organization Name:SPINAL DISORDERS AND PAIN TREATMENT INSTITUTE
Other - Org Name:PAIN INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-521-5489
Mailing Address - Street 1:6006 49TH ST N
Mailing Address - Street 2:SUITE 350
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-2148
Mailing Address - Country:US
Mailing Address - Phone:727-521-5489
Mailing Address - Fax:
Practice Address - Street 1:6006 49TH ST N
Practice Address - Street 2:SUITE 350
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-2148
Practice Address - Country:US
Practice Address - Phone:727-521-5489
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL300202300Medicaid
FLGRP DG0621OtherRR MEDICARE
FLP00412279OtherRR MEDICARE
FL300202300Medicaid