Organization
MARION PAIN MANAGEMENT CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MANGALA SHETTY MD (OWNER)
(352) 622-1840
Entity
Organization
Contact information
Practice address
1737A SE 28TH LOOP, OCALA, FL 34471-1079
(352) 622-1840
(352) 622-0137
Mailing address
PO BOX 917572, ORLANDO, FL 32891-7572
(888) 877-3850
(631) 329-6951
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
—
—
208VP0000X
Pain Medicine Physician
—
—
208VP0014X
Interventional Pain Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
254258700
—
FL
Enumeration date
10/11/2006
Last updated
02/02/2010
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