Provider Demographics
NPI:1558761403
Name:H8PAIN PAIN MANAGEMENT CENTER OF TEXAS PLLC
Entity Type:Organization
Organization Name:H8PAIN PAIN MANAGEMENT CENTER OF TEXAS PLLC
Other - Org Name:THE PAIN MANAGEMENT CENTER OF TEXAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:THEESFELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-753-7333
Mailing Address - Street 1:3217 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-5145
Mailing Address - Country:US
Mailing Address - Phone:903-753-7333
Mailing Address - Fax:903-753-4849
Practice Address - Street 1:3217 N 4TH ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-5145
Practice Address - Country:US
Practice Address - Phone:903-753-7333
Practice Address - Fax:903-753-4849
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:H8PAIN PAIN MANAGEMENT CENTER OF TEXAS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-28
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3712208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXJ3712OtherTEXAS LICENSE
TX7333460001Medicare NSC