Provider Demographics
NPI:1205979291
Name:KETI MEDICAL CENTER & PAIN MANAGEMENT INC
Entity type:Organization
Organization Name:KETI MEDICAL CENTER & PAIN MANAGEMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHYAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:SWAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-596-1339
Mailing Address - Street 1:7105 MARINER BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-1048
Mailing Address - Country:US
Mailing Address - Phone:352-596-1339
Mailing Address - Fax:352-596-8772
Practice Address - Street 1:7105 MARINER BLVD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-1048
Practice Address - Country:US
Practice Address - Phone:352-596-1339
Practice Address - Fax:352-596-8772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty