Provider Demographics
NPI:1639456692
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:352-343-6900
Mailing Address - Street 1:8136 CENTRALIA CT
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788-3757
Mailing Address - Country:US
Mailing Address - Phone:352-343-6900
Mailing Address - Fax:
Practice Address - Street 1:800 COUNTY ROAD 466
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159
Practice Address - Country:US
Practice Address - Phone:352-343-6900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-04
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty