Provider Demographics
NPI:1982637088
Name:NORTH DALLAS PAIN MANAGEMENT CENTER, P.A.
Entity Type:Organization
Organization Name:NORTH DALLAS PAIN MANAGEMENT CENTER, P.A.
Other - Org Name:COMPREHENSIVE PAIN MANAGEMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:J
Authorized Official - Last Name:TARIQ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-316-3344
Mailing Address - Street 1:6505 W PARK BLVD STE 306-PMB # 376
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-6208
Mailing Address - Country:US
Mailing Address - Phone:972-316-3344
Mailing Address - Fax:972-316-3322
Practice Address - Street 1:1850 LAKEPOINTE DR STE 100
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-6443
Practice Address - Country:US
Practice Address - Phone:972-316-3344
Practice Address - Fax:972-316-3322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X, 207L00000X, 208VP0000X
TX9368111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX720000125OtherMEDICARE RAILROAD INDIVID
TXCJ8159OtherMEDICARE RAILROAD GROUP
TX030369501Medicaid
TXP00331394OtherMEDICARE RAILROAD INDIVID
TX184682601Medicaid
TX184681801Medicaid
TXCJ8159OtherMEDICARE RAILROAD GROUP
TX00449RMedicare PIN
TXCJ8159OtherMEDICARE RAILROAD GROUP
TXP00331394OtherMEDICARE RAILROAD INDIVID
TX8954M0Medicare PIN