Provider Demographics
NPI: | 1750839866 |
---|---|
Name: | PAIN INSTITUTE OF AMERICA, PLLC |
Entity Type: | Organization |
Organization Name: | PAIN INSTITUTE OF AMERICA, PLLC |
Other - Org Name: | ADVANCED PAIN INSTITUTE |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | MANAGER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | TONY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | JULIUS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 972-866-4246 |
Mailing Address - Street 1: | 2201 LONG PRAIRIE RD |
Mailing Address - Street 2: | SUITE 107 #358 |
Mailing Address - City: | FLOWER MOUND |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 75022-4964 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 972-866-4246 |
Mailing Address - Fax: | 972-866-4249 |
Practice Address - Street 1: | 500 W MAIN ST |
Practice Address - Street 2: | SUITE 230 |
Practice Address - City: | LEWISVILLE |
Practice Address - State: | TX |
Practice Address - Zip Code: | 75057-3641 |
Practice Address - Country: | US |
Practice Address - Phone: | 972-866-4246 |
Practice Address - Fax: | 972-866-4249 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2016-09-18 |
Last Update Date: | 2022-07-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 174400000X | Other Service Providers | Specialist | Group - Single Specialty |