Provider Demographics
NPI:1083151369
Name:PAIN MANAGEMENT & DIAGNOSTIC CENTER
Entity Type:Organization
Organization Name:PAIN MANAGEMENT & DIAGNOSTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RENAUD
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-265-9991
Mailing Address - Street 1:8440 WALNUT HILL LN
Mailing Address - Street 2:STE 340
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-3833
Mailing Address - Country:US
Mailing Address - Phone:214-265-9991
Mailing Address - Fax:
Practice Address - Street 1:8440 WALNUT HILL LN
Practice Address - Street 2:STE 340
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3833
Practice Address - Country:US
Practice Address - Phone:214-265-9991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-25
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4214207L00000X, 207LP2900X
208VP0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty