Provider Demographics
NPI:1528105921
Name:PAIN AND PRIMARY CARE CENTER, PA
Entity type:Organization
Organization Name:PAIN AND PRIMARY CARE CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOTERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-764-9355
Mailing Address - Street 1:702 N ALEXANDER ST
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-3064
Mailing Address - Country:US
Mailing Address - Phone:813-764-9355
Mailing Address - Fax:813-764-0695
Practice Address - Street 1:702 N ALEXANDER ST
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-3064
Practice Address - Country:US
Practice Address - Phone:813-764-9355
Practice Address - Fax:813-764-0695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH3897OtherRAILROAD MEDICARE
FLK1907Medicare ID - Type Unspecified
FL5036850001Medicare NSC