| Integra Neuro Pain Institute Pa | |
|
5979 Vineland Rd Ste 114 Orlando FL 32819-7855 | |
| (863) 547-0788 | |
| (863) 547-0789 |
| Full Name | Integra Neuro Pain Institute Pa |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 5979 Vineland Rd Ste 114, Orlando, Florida |
| Authorized Official Name and Position | Mohammad Masoom Qureshi (PRESIDENT/PHYSICIAN) |
| Authorized Official Contact | 8635470788 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Integra Neuro Pain Institute Pa 8297 Champions Gate Blvd Ste 463 Champions Gate FL 33896-8387 Ph: (863) 547-0788 | Integra Neuro Pain Institute Pa 5979 Vineland Rd Ste 114 Orlando FL 32819-7855 Ph: (863) 547-0788 |
| NPI Number | 1881158939 |
|---|---|
| Provider Enumeration Date | 01/23/2019 |
| Last Update Date | 04/17/2023 |
| Certification Date | 04/17/2023 |
| Medicare PECOS PAC ID | 6103153416 |
|---|---|
| Medicare Enrollment ID | O20191021001792 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881158939 | NPI | - | NPPES |
| 021662900 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| 2084P2900X | Psychiatry & Neurology - Pain Medicine | (* (Not Available)) | Secondary |
| Provider Name | Mohammad Qureshi |
|---|---|
| Provider Type | Practitioner - Interventional Pain Management |
| Provider Identifiers | NPI Number: 1588002505 PECOS PAC ID: 8628357597 Enrollment ID: I20170713002361 |
| Provider Name | Inga Jennings |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427602820 PECOS PAC ID: 9638401227 Enrollment ID: I20191031001622 |
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