Provider Demographics
NPI:1518993211
Name:OMEGA PAIN CENTER, PA
Entity Type:Organization
Organization Name:OMEGA PAIN CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARIF
Authorized Official - Middle Name:BASIR
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-952-0290
Mailing Address - Street 1:PO BOX 678054
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-8054
Mailing Address - Country:US
Mailing Address - Phone:972-952-0290
Mailing Address - Fax:
Practice Address - Street 1:2201 N CENTRAL EXPY STE 171
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-2763
Practice Address - Country:US
Practice Address - Phone:972-952-0290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5788174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0002KDOtherBLUE CROSS BLUE SHIELD
TX0002KDOtherBLUE CROSS BLUE SHIELD