Provider Demographics
NPI:1851565717
Name:PAIN MANAGEMENT CENTER OF DALLAS
Entity Type:Organization
Organization Name:PAIN MANAGEMENT CENTER OF DALLAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:J
Authorized Official - Last Name:RAMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-370-4000
Mailing Address - Street 1:712 N WASHINGTON AVE
Mailing Address - Street 2:STE 404
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1619
Mailing Address - Country:US
Mailing Address - Phone:214-370-4000
Mailing Address - Fax:214-370-4008
Practice Address - Street 1:712 N WASHINGTON AVE
Practice Address - Street 2:STE 404
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1619
Practice Address - Country:US
Practice Address - Phone:214-370-4000
Practice Address - Fax:214-370-4008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1167174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00529KMedicare UPIN