Organization
PAIN CENTER OF ORLANDO
Active
Other names
PAIN CENTER OF ORLANDO
Organization subpart
No
Provider details
NPI number
Authorized official
DIRENDIA SHACKELFORD (MANAGED CARE SPECIALIST)
(800) 654-0889
Entity
Organization
Contact information
Practice address
225 W STATE RD 434 205, ORLANDO, FL 32750
(407) 679-3337
(407) 678-7246
Mailing address
225 W STATE RD 434 205, ORLANDO, FL 32750
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
ME81513
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1011181
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
2000328
—
FL
Enumeration date
10/24/2006
Last updated
08/22/2020
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