Provider Demographics
NPI:1376205864
Name:AMERICAN PAIN & WELLNESS PA
Entity Type:Organization
Organization Name:AMERICAN PAIN & WELLNESS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KRETZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-326-5115
Mailing Address - Street 1:1417 GABLES CT STE 201
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-7648
Mailing Address - Country:US
Mailing Address - Phone:469-326-5115
Mailing Address - Fax:
Practice Address - Street 1:5400 STATE HIGHWAY 121 STE 100
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-5929
Practice Address - Country:US
Practice Address - Phone:817-479-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERICAN PAIN AND WELLNESS, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-12
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty