Provider Demographics
NPI:1902012677
Name:PRESTON PAIN INSTITUTE
Entity Type:Organization
Organization Name:PRESTON PAIN INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-488-9991
Mailing Address - Street 1:PO BOX 702453
Mailing Address - Street 2:12800 PRESTON ROAD SUITE # 201
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230
Mailing Address - Country:US
Mailing Address - Phone:972-386-9111
Mailing Address - Fax:972-386-9118
Practice Address - Street 1:12800 PRESTON ROAD
Practice Address - Street 2:PRESTON PAIN INSTITUTE SUITE # 201
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230
Practice Address - Country:US
Practice Address - Phone:972-386-9111
Practice Address - Fax:972-386-9118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR30913208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty