Provider Demographics
NPI:1013472265
Name:PREMIERE PAIN SPECIALISTS LLC
Entity Type:Organization
Organization Name:PREMIERE PAIN SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE DEPT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BILLINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-655-4362
Mailing Address - Street 1:12309 N MOPAC EXPY STE 125
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-2577
Mailing Address - Country:US
Mailing Address - Phone:512-206-8000
Mailing Address - Fax:
Practice Address - Street 1:12309 N MOPAC EXPY STE 125
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-2577
Practice Address - Country:US
Practice Address - Phone:512-206-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-01
Last Update Date:2020-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXM3402OtherSTATE LICENSE