Organization
TRINITY PAIN CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERRY M BUSH (OFFICE MANAGER)
(727) 264-8865
Entity
Organization
Contact information
Practice address
8146 CEREBELLUM WAY, SUITE 102, TRINITY, FL 34655-1784
(727) 264-8865
(855) 801-6125
Mailing address
8146 CEREBELLUM WAY, SUITE 102, TRINITY, FL 34655-1784
(727) 264-8865
(727) 608-4479
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
ME98246
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DD544A
MEDICARE PTAN
FL
Enumeration date
04/06/2010
Last updated
11/08/2021
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