Provider Demographics
NPI:1538398995
Name:PAIN HEALING CENTER LLC
Entity type:Organization
Organization Name:PAIN HEALING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ABD
Authorized Official - Middle Name:ALRAHMAN
Authorized Official - Last Name:BENNI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-367-6986
Mailing Address - Street 1:1749 S KINGS AVE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-6220
Mailing Address - Country:US
Mailing Address - Phone:813-333-1819
Mailing Address - Fax:813-413-7835
Practice Address - Street 1:1749 S KINGS AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-6220
Practice Address - Country:US
Practice Address - Phone:813-333-1819
Practice Address - Fax:813-413-7835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-07
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME102050207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty