Provider Demographics
NPI:1962955765
Name:OMNI PAIN CARE, LLC
Entity type:Organization
Organization Name:OMNI PAIN CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SIDHARTH
Authorized Official - Middle Name:
Authorized Official - Last Name:PANCHAMIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-533-5522
Mailing Address - Street 1:3140 S FALKENBURG RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-2574
Mailing Address - Country:US
Mailing Address - Phone:813-533-5522
Mailing Address - Fax:813-533-5511
Practice Address - Street 1:3140 S FALKENBURG RD
Practice Address - Street 2:SUITE 205
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-2574
Practice Address - Country:US
Practice Address - Phone:813-533-5522
Practice Address - Fax:813-533-5511
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OMNI CONCEPTS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-27
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME106682208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty