Provider Demographics
NPI:1922148550
Name:CEDAR HILL PAIN & REHAB, PA
Entity Type:Organization
Organization Name:CEDAR HILL PAIN & REHAB, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:DAGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:972-291-9165
Mailing Address - Street 1:PO BOX 222093
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75222-2093
Mailing Address - Country:US
Mailing Address - Phone:972-291-9165
Mailing Address - Fax:972-291-5976
Practice Address - Street 1:716 N HIGHWAY 67 STE 2
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-2117
Practice Address - Country:US
Practice Address - Phone:972-291-9165
Practice Address - Fax:469-575-9975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular MedicineGroup - Multi-Specialty
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0096PSOtherBCBS
TX0096PSOtherBCBS