Provider Demographics
NPI:1104377092
Name:PAIN MANAGEMENT PHYSICIANS OF DALLAS, PLLC.
Entity Type:Organization
Organization Name:PAIN MANAGEMENT PHYSICIANS OF DALLAS, PLLC.
Other - Org Name:DALLAS PAIN CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:T
Authorized Official - Last Name:KRAUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-948-7700
Mailing Address - Street 1:1411 N BECKLEY AVE
Mailing Address - Street 2:SUITE# 152
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203-1259
Mailing Address - Country:US
Mailing Address - Phone:214-948-7700
Mailing Address - Fax:214-948-7701
Practice Address - Street 1:2821 E PRESIDENT GEORGE BUSH HWY
Practice Address - Street 2:SUITE# 410
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-4266
Practice Address - Country:US
Practice Address - Phone:214-948-7700
Practice Address - Fax:214-948-7701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-17
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6511110001Medicare NSC