Provider Demographics
NPI:1609892074
Name:THE PAIN REHABILITATION GROUP OF WICHITA FALLS P.A.
Entity Type:Organization
Organization Name:THE PAIN REHABILITATION GROUP OF WICHITA FALLS P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:WORKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-696-8500
Mailing Address - Street 1:4301 MAPLEWOOD AVE
Mailing Address - Street 2:STE A
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-3879
Mailing Address - Country:US
Mailing Address - Phone:940-696-8500
Mailing Address - Fax:940-696-8546
Practice Address - Street 1:4301 MAPLEWOOD AVE
Practice Address - Street 2:STE A
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308
Practice Address - Country:US
Practice Address - Phone:940-696-8500
Practice Address - Fax:940-696-8546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX079982701Medicaid