Provider Demographics
NPI:1760598577
Name:ACUTE & CHRONIC PAIN MANAGEMENT CENTER PA
Entity Type:Organization
Organization Name:ACUTE & CHRONIC PAIN MANAGEMENT CENTER PA
Other - Org Name:ACUTE & CHRONIC PAIN AND SPINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAYDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRADDICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-353-6100
Mailing Address - Street 1:24 CARE CIR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79124-2118
Mailing Address - Country:US
Mailing Address - Phone:806-353-6100
Mailing Address - Fax:806-353-3372
Practice Address - Street 1:24 CARE CIR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79124-2118
Practice Address - Country:US
Practice Address - Phone:806-353-6100
Practice Address - Fax:806-353-3372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
204R00000X, 207RC0000X, 207RC0001X, 207RI0011X, 2080P0202X, 2085R0203X, 2085R0204X, 208600000X, 2086S0129X, 208G00000X
TX007835261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Multi-Specialty
No204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Multi-Specialty
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic RadiologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0083BMMedicare PIN
TXASC162Medicare PIN