Provider Demographics
NPI:1134453129
Name:PREMIER INTERVENTIONAL PAIN MANAGEMENT, P.L.L.C
Entity type:Organization
Organization Name:PREMIER INTERVENTIONAL PAIN MANAGEMENT, P.L.L.C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:VU
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:210-365-2509
Mailing Address - Street 1:3001 CROSS TIMBERS RD STE 120
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-2800
Mailing Address - Country:US
Mailing Address - Phone:972-350-0225
Mailing Address - Fax:972-350-0228
Practice Address - Street 1:3001 CROSS TIMBERS RD STE 120
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-2800
Practice Address - Country:US
Practice Address - Phone:972-350-0225
Practice Address - Fax:972-350-0228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-24
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6406720001Medicare NSC