Provider Demographics
NPI:1649450511
Name:PAIN MANAGEMENT HOLDINGS, PA
Entity type:Organization
Organization Name:PAIN MANAGEMENT HOLDINGS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-317-4666
Mailing Address - Street 1:PO BOX 831655
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75083-1655
Mailing Address - Country:US
Mailing Address - Phone:214-317-4666
Mailing Address - Fax:214-317-4667
Practice Address - Street 1:4040 N MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-6413
Practice Address - Country:US
Practice Address - Phone:214-317-4666
Practice Address - Fax:214-317-4667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain