Provider Demographics
NPI:1003835133
Name:PREMIER PAIN CONSULTANTS, PLLC
Entity Type:Organization
Organization Name:PREMIER PAIN CONSULTANTS, PLLC
Other - Org Name:PREMIER PAIN CONSULTANTS, P.A.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DMITRIY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUYANOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-616-9400
Mailing Address - Street 1:2425 BABCOCK RD STE 108
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4899
Mailing Address - Country:US
Mailing Address - Phone:210-616-9400
Mailing Address - Fax:210-616-9402
Practice Address - Street 1:2425 BABCOCK RD STE 108
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4899
Practice Address - Country:US
Practice Address - Phone:210-616-9400
Practice Address - Fax:210-616-9402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDC9627OtherMEDICARE RAILROAD PTAN
TX178257501Medicaid
TX178257502Medicaid
TXDC9627OtherMEDICARE RAILROAD PTAN
TXTXB156231Medicare PIN
TX178257501Medicaid