Provider Demographics
NPI:1790308500
Name:ADVANCED PRACTICE PAIN MANAGEMENT AND ANESTHESIA CONSULTING PLLC
Entity Type:Organization
Organization Name:ADVANCED PRACTICE PAIN MANAGEMENT AND ANESTHESIA CONSULTING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-720-1459
Mailing Address - Street 1:1110 TURNER DR
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-6750
Mailing Address - Country:US
Mailing Address - Phone:903-655-4814
Mailing Address - Fax:833-654-0699
Practice Address - Street 1:325 WILSON ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TX
Practice Address - Zip Code:75652-5957
Practice Address - Country:US
Practice Address - Phone:903-655-4814
Practice Address - Fax:833-654-0699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-27
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty