Basic Information
| Provider Information | |||||||||
| NPI: | 1285903245 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LEBANON PAIN RELIEF CENTER PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4919 MEMORIAL HWY STE 200 | ||||||||
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| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336347500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8666317890 | ||||||||
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| Practice Location | |||||||||
| Address1: | 600 ISABEL DR STE 3 | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170423500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172727272 | ||||||||
| FaxNumber: | 7172720072 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2011 | ||||||||
| LastUpdateDate: | 04/26/2021 | ||||||||
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| AuthorizedOfficialLastName: | BALDOCK | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
| AuthorizedOfficialMiddleName: | BOYD | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICER AND AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 6152345900 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.