Provider Demographics
NPI:1598763245
Name:TEXAS PAIN REHABILITATION INSTITUTE, PA
Entity Type:Organization
Organization Name:TEXAS PAIN REHABILITATION INSTITUTE, PA
Other - Org Name:TEXAS REHABILITATION INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GRAVES
Authorized Official - Middle Name:T
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-310-7246
Mailing Address - Street 1:7200 WYOMING SPGS STE 400
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4304
Mailing Address - Country:US
Mailing Address - Phone:512-310-7246
Mailing Address - Fax:512-310-7667
Practice Address - Street 1:7200 WYOMING SPGS
Practice Address - Street 2:STE 400
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4304
Practice Address - Country:US
Practice Address - Phone:512-310-7246
Practice Address - Fax:512-310-7667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00U90JMedicare PIN