Provider Demographics
NPI:1164420345
Name:PAIN NET PHYSICIANS GROUP, P.A.
Entity Type:Organization
Organization Name:PAIN NET PHYSICIANS GROUP, P.A.
Other - Org Name:PAIN NET PHYSICIANS GROUP AND PAIN NET PHYSICIANS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:NATHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-239-2190
Mailing Address - Street 1:9500 FOREST LN
Mailing Address - Street 2:SUITE 110
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-5935
Mailing Address - Country:US
Mailing Address - Phone:972-239-2190
Mailing Address - Fax:972-239-7946
Practice Address - Street 1:9500 FOREST LN
Practice Address - Street 2:SUITE 110
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-5935
Practice Address - Country:US
Practice Address - Phone:972-239-2190
Practice Address - Fax:972-239-7946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF003070111N00000X
TXR17981261Q00000X
TXG5619261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Not Answered261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Not Answered261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPainGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00807WMedicare ID - Type Unspecified