Organization
PAIN DIAGNOSTIC & MANAGEMENT CENTER LLC
Active
Other names
Pain Diagnostic & Management Center
Organization subpart
No
Provider details
NPI number
Authorized official
PEGGY E VENT (BILLING REP)
(813) 685-2191
Entity
Organization
Contact information
Practice address
537 E CENTRAL AVE, WINTER HAVEN, FL 33880-3054
(863) 293-3656
(863) 293-7887
Mailing address
321 E ROBERTSON ST, BRANDON, FL 33511-5253
(813) 685-2191
(813) 689-8755
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
593467412
TAX ID
FL
Enumeration date
09/02/2006
Last updated
04/22/2010
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