Provider Demographics
NPI:1902006729
Name:PAIN MANAGEMENT HOLDINGS
Entity Type:Organization
Organization Name:PAIN MANAGEMENT HOLDINGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MRUGESHKUMAR
Authorized Official - Middle Name:KANAIYALAL
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-504-4843
Mailing Address - Street 1:PO BOX 831655
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75083-1655
Mailing Address - Country:US
Mailing Address - Phone:617-504-4843
Mailing Address - Fax:
Practice Address - Street 1:1001 PALM DESERT DR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-5011
Practice Address - Country:US
Practice Address - Phone:617-504-4843
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8442207LP2900X
TXL6174208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty