Provider Demographics
NPI:1710280326
Name:PREMIER PAIN CONSULTANTS, PA
Entity Type:Organization
Organization Name:PREMIER PAIN CONSULTANTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:YURII
Authorized Official - Middle Name:D
Authorized Official - Last Name:BORSHCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-616-9400
Mailing Address - Street 1:PO BOX 26
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78291
Mailing Address - Country:US
Mailing Address - Phone:210-616-9400
Mailing Address - Fax:210-616-9402
Practice Address - Street 1:18626 HARDY OAK
Practice Address - Street 2:SUITE 215
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258
Practice Address - Country:US
Practice Address - Phone:210-616-9400
Practice Address - Fax:210-616-9404
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER PAIN CONSULTANTS, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-21
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2907207L00000X
TXN3706207LP2900X
TXL7996208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178257501Medicaid
TX178257501Medicaid