Provider Demographics
NPI:1225190366
Name:DESOTO PAIN PARTNERS, LP
Entity Type:Organization
Organization Name:DESOTO PAIN PARTNERS, LP
Other - Org Name:WHEATLAND PROCEDURE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:TED
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSEBECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-682-6742
Mailing Address - Street 1:PO BOX 269006
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126
Mailing Address - Country:US
Mailing Address - Phone:972-479-1129
Mailing Address - Fax:972-479-1118
Practice Address - Street 1:1026 E WHEATLAND RD
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116
Practice Address - Country:US
Practice Address - Phone:972-234-4740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain