Provider Demographics
NPI:1457682841
Name:PAIN CARE OF NORTH TEXAS
Entity Type:Organization
Organization Name:PAIN CARE OF NORTH TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRUMLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-509-9530
Mailing Address - Street 1:1111 RAINTREE CIR
Mailing Address - Street 2:STE 190
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-4901
Mailing Address - Country:US
Mailing Address - Phone:214-509-9530
Mailing Address - Fax:214-509-0240
Practice Address - Street 1:1111 RAINTREE CIR
Practice Address - Street 2:STE 190
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-4901
Practice Address - Country:US
Practice Address - Phone:214-509-9530
Practice Address - Fax:214-509-0240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-25
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008093261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXASC218Medicare PIN