Provider Demographics
NPI:1598745317
Name:PAIN CARE PHYSICIANS, PA
Entity Type:Organization
Organization Name:PAIN CARE PHYSICIANS, PA
Other - Org Name:SPINE DIAGNOSTIC AND TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANAND
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-326-5440
Mailing Address - Street 1:2315 W BEN WHITE BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-7524
Mailing Address - Country:US
Mailing Address - Phone:512-326-5440
Mailing Address - Fax:512-326-8660
Practice Address - Street 1:2315 W BEN WHITE BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7524
Practice Address - Country:US
Practice Address - Phone:512-326-5440
Practice Address - Fax:512-326-8660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8005208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX161651801Medicaid
TX161651801Medicaid
TX6380590001Medicare NSC
TX00831TMedicare PIN