Provider Demographics
NPI:1760701809
Name:360 PAIN AND REHABILITATION PLLC
Entity Type:Organization
Organization Name:360 PAIN AND REHABILITATION PLLC
Other - Org Name:PAIN CENTER AUSTIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MORGAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:KRULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-363-5779
Mailing Address - Street 1:PO BOX 9135
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78469-9135
Mailing Address - Country:US
Mailing Address - Phone:512-368-2200
Mailing Address - Fax:512-363-2201
Practice Address - Street 1:2200 PARK BEND DR
Practice Address - Street 2:BLGD 1, SUITE 201
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-5387
Practice Address - Country:US
Practice Address - Phone:512-368-2200
Practice Address - Fax:512-363-2201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-28
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB112262Medicare PIN
TX6424630001Medicare NSC
TXTXB112263Medicare PIN