Provider Demographics
NPI:1477288793
Name:THE KNEE PAIN CENTER, PLLC
Entity Type:Organization
Organization Name:THE KNEE PAIN CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN (CEO)
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-928-1697
Mailing Address - Street 1:8611 HILLCREST AVE STE 200B
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-4203
Mailing Address - Country:US
Mailing Address - Phone:469-399-5672
Mailing Address - Fax:
Practice Address - Street 1:8611 HILLCREST AVE STE 200B
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-4203
Practice Address - Country:US
Practice Address - Phone:469-399-5672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty