Provider Demographics
NPI:1942587902
Name:PAIN AND SPINE CENTERS OF FLORIDA LLC
Entity Type:Organization
Organization Name:PAIN AND SPINE CENTERS OF FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:SRIDHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:PINNAMANENI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-343-7246
Mailing Address - Street 1:2146 VINDALE RD
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-5602
Mailing Address - Country:US
Mailing Address - Phone:352-343-7246
Mailing Address - Fax:352-259-8959
Practice Address - Street 1:2146 VINDALE RD
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-5602
Practice Address - Country:US
Practice Address - Phone:352-343-7246
Practice Address - Fax:352-259-8959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty