Provider Demographics
NPI:1609962661
Name:CRISTY M SCHADE MD PA
Entity Type:Organization
Organization Name:CRISTY M SCHADE MD PA
Other - Org Name:CENTER FOR PAIN CONTROL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CRISTY
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:SCHADE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-494-2676
Mailing Address - Street 1:2692 W WALNUT ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-6474
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2692 W WALNUT ST
Practice Address - Street 2:SUITE 105
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-6474
Practice Address - Country:US
Practice Address - Phone:972-494-2676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF1971174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177155201Medicaid
TX00419XMedicare PIN