Provider Demographics
NPI:1306274048
Name:UNIVERSITY PAIN ASSOCIATES, LLC
Entity type:Organization
Organization Name:UNIVERSITY PAIN ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:N
Authorized Official - Last Name:KOZLOV
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:727-822-3500
Mailing Address - Street 1:204 37TH AVE N
Mailing Address - Street 2:#125
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-1416
Mailing Address - Country:US
Mailing Address - Phone:727-822-3500
Mailing Address - Fax:727-822-3228
Practice Address - Street 1:431 SOUTHWEST BLVD N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-1399
Practice Address - Country:US
Practice Address - Phone:727-822-3500
Practice Address - Fax:727-822-3228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-15
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS11865207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty