Provider Demographics
NPI:1225554165
Name:SOUTHWEST JOINT PAIN MANAGEMENT, LLC
Entity Type:Organization
Organization Name:SOUTHWEST JOINT PAIN MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HOWINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:972-743-2126
Mailing Address - Street 1:2452 LAKEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054-6800
Mailing Address - Country:US
Mailing Address - Phone:972-743-2126
Mailing Address - Fax:214-988-2082
Practice Address - Street 1:8611 HILLCREST RD, SUITE 245D
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225
Practice Address - Country:US
Practice Address - Phone:972-743-2126
Practice Address - Fax:214-988-2082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-22
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70862367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty