Provider Demographics
NPI:1659485894
Name:LEGACY PAIN ASSOCIATES, P.A.
Entity type:Organization
Organization Name:LEGACY PAIN ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:BARHORST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-953-2280
Mailing Address - Street 1:PO BOX 679113
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-8205
Mailing Address - Country:US
Mailing Address - Phone:832-953-2280
Mailing Address - Fax:832-953-2829
Practice Address - Street 1:9201 PINECROFT DR STE 200
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-3889
Practice Address - Country:US
Practice Address - Phone:832-953-2280
Practice Address - Fax:832-953-2829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00U01ZMedicare PIN