Provider Demographics
NPI:1619244720
Name:TRICITY PAIN ASSOCIATES PA
Entity Type:Organization
Organization Name:TRICITY PAIN ASSOCIATES PA
Other - Org Name:PHASE 4 PHYSIOTHERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:URFAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-268-0129
Mailing Address - Street 1:19141 STONE OAK PKWY STE 104
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3367
Mailing Address - Country:US
Mailing Address - Phone:210-268-0129
Mailing Address - Fax:210-568-4064
Practice Address - Street 1:110 STONE OAK LOOP STE 103
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3511
Practice Address - Country:US
Practice Address - Phone:210-268-0129
Practice Address - Fax:210-314-4609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-18
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB146540Medicare PIN