Provider Demographics
NPI:1922617125
Name:PAIN MANAGEMENT SPECIALISTS
Entity Type:Organization
Organization Name:PAIN MANAGEMENT SPECIALISTS
Other - Org Name:MEDICAL PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:AKINTOMI
Authorized Official - Middle Name:A
Authorized Official - Last Name:OLUGBODI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-568-5078
Mailing Address - Street 1:PO BOX 734812
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-4812
Mailing Address - Country:US
Mailing Address - Phone:210-358-9500
Mailing Address - Fax:210-358-9183
Practice Address - Street 1:2425 BABCOCK RD STE 111
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4899
Practice Address - Country:US
Practice Address - Phone:210-358-3108
Practice Address - Fax:210-702-4750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-24
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty