Provider Demographics
NPI:1629506357
Name:VANGUARD PAIN MANAGEMENT, PLLC
Entity Type:Organization
Organization Name:VANGUARD PAIN MANAGEMENT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:H
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-516-8811
Mailing Address - Street 1:700 HIGHLANDER BLVD STE 415
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-4346
Mailing Address - Country:US
Mailing Address - Phone:817-330-1102
Mailing Address - Fax:817-516-8444
Practice Address - Street 1:9080 HARRY HINES BLVD STE 110
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-1700
Practice Address - Country:US
Practice Address - Phone:214-637-0887
Practice Address - Fax:214-637-0886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-25
Last Update Date:2017-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty