Provider Demographics
NPI:1578155115
Name:TEXAS INTERVENTIONAL PAIN MANAGEMENT, PLLC
Entity Type:Organization
Organization Name:TEXAS INTERVENTIONAL PAIN MANAGEMENT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MERIWETHER
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:FRAZIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-476-6593
Mailing Address - Street 1:5425 W SPRING CREEK PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-4268
Mailing Address - Country:US
Mailing Address - Phone:972-596-1059
Mailing Address - Fax:972-612-5410
Practice Address - Street 1:17051 DALLAS PKWY STE 320
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-7112
Practice Address - Country:US
Practice Address - Phone:972-596-1059
Practice Address - Fax:972-612-5410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
123456OtherUNKNOWN