Provider Demographics
NPI:1457779894
Name:PREMIER PAIN CARE PA
Entity Type:Organization
Organization Name:PREMIER PAIN CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-323-9404
Mailing Address - Street 1:2435 W OAK ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-2308
Mailing Address - Country:US
Mailing Address - Phone:940-323-9404
Mailing Address - Fax:
Practice Address - Street 1:2435 W OAK ST
Practice Address - Street 2:SUITE 103
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-2308
Practice Address - Country:US
Practice Address - Phone:940-323-9404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX532130363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty