Provider Demographics
NPI:1346519212
Name:MIDTOWN INTERVENTIONAL PAIN CENTER LLD
Entity Type:Organization
Organization Name:MIDTOWN INTERVENTIONAL PAIN CENTER LLD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TED
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSBECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-362-6909
Mailing Address - Street 1:PO BOX 674231
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-4231
Mailing Address - Country:US
Mailing Address - Phone:972-479-1115
Mailing Address - Fax:972-346-8015
Practice Address - Street 1:911 W ANDERSON LN
Practice Address - Street 2:STE 104
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-1501
Practice Address - Country:US
Practice Address - Phone:512-467-1100
Practice Address - Fax:512-647-1101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain