Provider Demographics
NPI:1124032412
Name:REGIONAL PAIN CARE OF NORTH TEXAS
Entity Type:Organization
Organization Name:REGIONAL PAIN CARE OF NORTH TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUMLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-509-9530
Mailing Address - Street 1:1111 RAINTREE CIR
Mailing Address - Street 2:STE. 170
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-4901
Mailing Address - Country:US
Mailing Address - Phone:214-509-9691
Mailing Address - Fax:214-509-9661
Practice Address - Street 1:1111 RAINTREE CIR
Practice Address - Street 2:STE. 170
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-4901
Practice Address - Country:US
Practice Address - Phone:214-509-9691
Practice Address - Fax:214-509-9661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0458174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00R73HMedicare ID - Type UnspecifiedGROUP PROVIDER NUMBER