Provider Demographics
NPI:1730153396
Name:UNIVERSITY PAIN MANAGEMENT CENTER INC
Entity type:Organization
Organization Name:UNIVERSITY PAIN MANAGEMENT CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAUKAT
Authorized Official - Middle Name:H
Authorized Official - Last Name:CHOWDHARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-977-2222
Mailing Address - Street 1:PO BOX 46518
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33646-0105
Mailing Address - Country:US
Mailing Address - Phone:813-977-2222
Mailing Address - Fax:813-977-4222
Practice Address - Street 1:11707 CLUB DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-5521
Practice Address - Country:US
Practice Address - Phone:813-977-2222
Practice Address - Fax:813-977-4222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-13
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0026925-00Medicaid
FLDE1204OtherRAILROAD MEDICARE
FL0026925-02Medicaid
FLK2903Medicare PIN