Provider Demographics
NPI:1215208905
Name:AJK MEDICAL SERVICES
Entity Type:Organization
Organization Name:AJK MEDICAL SERVICES
Other - Org Name:WELLSPRING PAIN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KLYMIUK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-690-0550
Mailing Address - Street 1:6750 HILLCREST PLAZA DR
Mailing Address - Street 2:SUITE 215
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-1400
Mailing Address - Country:US
Mailing Address - Phone:972-690-0550
Mailing Address - Fax:972-690-3306
Practice Address - Street 1:6750 HILLCREST PLAZA DR
Practice Address - Street 2:SUITE 215
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1400
Practice Address - Country:US
Practice Address - Phone:972-690-0550
Practice Address - Fax:972-690-3306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-26
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK82652084P0800X, 2084P0802X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1326264037OtherNPI
TXH30530Medicare UPIN