Provider Demographics
NPI:1275048258
Name:BLOSSOM NEUROLOGY CENTERS LLC
Entity Type:Organization
Organization Name:BLOSSOM NEUROLOGY CENTERS LLC
Other - Org Name:DENTON PAIN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-239-7771
Mailing Address - Street 1:PO BOX 8887
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75404-8887
Mailing Address - Country:US
Mailing Address - Phone:888-345-4115
Mailing Address - Fax:
Practice Address - Street 1:721 S I 35 E STE 142
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205-8153
Practice Address - Country:US
Practice Address - Phone:940-239-7771
Practice Address - Fax:888-751-5345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty