Provider Demographics
NPI:1538706718
Name:CONSULTANTS IN PAIN MEDICINE, PLLC
Entity Type:Organization
Organization Name:CONSULTANTS IN PAIN MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-546-1400
Mailing Address - Street 1:45 NE LOOP 410 STE 850
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-5824
Mailing Address - Country:US
Mailing Address - Phone:210-805-9800
Mailing Address - Fax:210-805-8770
Practice Address - Street 1:332 W SUNSET RD STE 3
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-1755
Practice Address - Country:US
Practice Address - Phone:210-805-9800
Practice Address - Fax:210-805-8770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-05
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXJ4240OtherTEXAS STATE LICENSE