Provider Demographics
NPI:1225063746
Name:PRACTICE PROFITABILITY SOLUTIONS, INC.
Entity Type:Organization
Organization Name:PRACTICE PROFITABILITY SOLUTIONS, INC.
Other - Org Name:SOUTHWEST PAIN MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:DELILLO
Authorized Official - Suffix:
Authorized Official - Credentials:DNP,CRNA, NSPM-C
Authorized Official - Phone:817-966-2762
Mailing Address - Street 1:1800 SABLE BAY LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76005-1304
Mailing Address - Country:US
Mailing Address - Phone:817-966-2762
Mailing Address - Fax:
Practice Address - Street 1:1800 SABLE BAY LN
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76005-1304
Practice Address - Country:US
Practice Address - Phone:817-966-2762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX514647367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00458RMedicare PIN