Provider Demographics
NPI:1568021087
Name:ALLEVIATE PAIN CENTER, PLLC
Entity Type:Organization
Organization Name:ALLEVIATE PAIN CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BENNETT
Authorized Official - Middle Name:
Authorized Official - Last Name:EZEKIEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:575-495-2668
Mailing Address - Street 1:4105 SINCLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-3524
Mailing Address - Country:US
Mailing Address - Phone:575-495-2668
Mailing Address - Fax:
Practice Address - Street 1:5801 MARVIN D LOVE FWY STE 105
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-2388
Practice Address - Country:US
Practice Address - Phone:214-305-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-08
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty