Basic Information
| Provider Information | |||||||||
| NPI: | 1295258051 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VERITAS INTERVENTIONAL PAIN & SPINE INSTITUTE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13242 FOX GLOVE ST | ||||||||
| Address2: | |||||||||
| City: | WINTER GARDEN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347874717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8884882702 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2209 NORTH BLVD W STE A | ||||||||
| Address2: | |||||||||
| City: | DAVENPORT | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338378903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8636798000 | ||||||||
| FaxNumber: | 8636798008 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2017 | ||||||||
| LastUpdateDate: | 09/20/2017 | ||||||||
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| AuthorizedOfficialLastName: | NARAYANASAMY | ||||||||
| AuthorizedOfficialFirstName: | NARENDREN | ||||||||
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| AuthorizedOfficialTitleorPosition: | MD | ||||||||
| AuthorizedOfficialTelephone: | 8636798000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | 2012028529 | MO | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 14Z0T | 01 | FL | BCBS | OTHER | 031919600 | 05 | FL | MEDICAID |