Provider Demographics
NPI:1467514695
Name:GARLAND AMBULATORY PAIN CENTER, LLC
Entity Type:Organization
Organization Name:GARLAND AMBULATORY PAIN CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:TED
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSEBECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-479-1129
Mailing Address - Street 1:PO BOX 268996
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-8996
Mailing Address - Country:US
Mailing Address - Phone:972-479-1129
Mailing Address - Fax:972-479-1118
Practice Address - Street 1:1778 N PLANO RD
Practice Address - Street 2:STE 300
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081
Practice Address - Country:US
Practice Address - Phone:972-234-4740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain