Provider Demographics
NPI:1154586923
Name:PAIN MANAGEMENT ASSOCIATES OF SWF
Entity type:Organization
Organization Name:PAIN MANAGEMENT ASSOCIATES OF SWF
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SWAROOP
Authorized Official - Middle Name:
Authorized Official - Last Name:MUPPAVARAPU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-206-7246
Mailing Address - Street 1:18350 MURDOCK CIR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-1008
Mailing Address - Country:US
Mailing Address - Phone:941-206-7246
Mailing Address - Fax:941-206-7248
Practice Address - Street 1:18350 MURDOCK CIR
Practice Address - Street 2:SUITE 101
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-1008
Practice Address - Country:US
Practice Address - Phone:941-206-7246
Practice Address - Fax:941-206-7248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97587207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277775400Medicaid
FLADO23ZMedicare PIN