Provider Demographics
NPI:1346235967
Name:LONE STAR PAIN INSTITUTE
Entity Type:Organization
Organization Name:LONE STAR PAIN INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:OTTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-599-4901
Mailing Address - Street 1:907 EAST EUREKA STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086
Mailing Address - Country:US
Mailing Address - Phone:817-599-4901
Mailing Address - Fax:817-599-4902
Practice Address - Street 1:907 EAST EUREKA STREET
Practice Address - Street 2:SUITE B
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-5866
Practice Address - Country:US
Practice Address - Phone:817-599-4901
Practice Address - Fax:817-599-4902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00544XMedicare ID - Type UnspecifiedPAIN MANAGEMENT
TX5596520001Medicare NSC