Provider Demographics
NPI:1750399200
Name:TAMPA PAIN CLINIC LLC
Entity type:Organization
Organization Name:TAMPA PAIN CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDERCAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-769-5629
Mailing Address - Street 1:3500 E FLETCHER AVE
Mailing Address - Street 2:ROOM 204
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-4708
Mailing Address - Country:US
Mailing Address - Phone:813-769-5629
Mailing Address - Fax:813-978-8797
Practice Address - Street 1:3500 E FLETCHER AVE
Practice Address - Street 2:ROOM 204
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4708
Practice Address - Country:US
Practice Address - Phone:813-769-5629
Practice Address - Fax:813-978-8797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME58829208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF34369Medicare PIN