Basic Information
| Provider Information | |||||||||
| NPI: | 1538155619 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEARTLAND QUALITLY PAIN MANAGEMENT PROFESSIONALS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4519 GEORGE RD | ||||||||
| Address2: | STE 100 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336347329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8134961075 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4145 SUN N LAKE BLVD | ||||||||
| Address2: | STE B | ||||||||
| City: | SEBRING | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338722131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8634025589 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2005 | ||||||||
| LastUpdateDate: | 02/23/2011 | ||||||||
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| AuthorizedOfficialLastName: | HIGH | ||||||||
| AuthorizedOfficialFirstName: | NANCY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 8633144466 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0014X | ME64529 | FL | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | 207LP2900X | ME64529 | FL | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 208VP0000X | ME64529 | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
No ID Information.