Provider Demographics
NPI:1427227958
Name:SHYAM PURSWANI, M.D. P.A.
Entity Type:Organization
Organization Name:SHYAM PURSWANI, M.D. P.A.
Other - Org Name:SOUTH TEXAS PAIN INSITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PURSWANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-590-9080
Mailing Address - Street 1:PO BOX 2458
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78298-2458
Mailing Address - Country:US
Mailing Address - Phone:210-590-9080
Mailing Address - Fax:210-590-9087
Practice Address - Street 1:2455 NE LOOP 410
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5649
Practice Address - Country:US
Practice Address - Phone:210-590-9080
Practice Address - Fax:210-590-9087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1005208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1703704-01Medicaid
TX1703704-03Medicaid
TX5234070001Medicare NSC
TX1703704-03Medicaid
TXG39302Medicare UPIN