Provider Demographics
NPI:1700443298
Name:SYNAPSE PAIN MANAGEMENT, PLLC
Entity Type:Organization
Organization Name:SYNAPSE PAIN MANAGEMENT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-215-3494
Mailing Address - Street 1:PO BOX 250889
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-0889
Mailing Address - Country:US
Mailing Address - Phone:214-390-7697
Mailing Address - Fax:888-770-6360
Practice Address - Street 1:2200 PHYSICIANS BLVD STE B
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-6248
Practice Address - Country:US
Practice Address - Phone:972-833-1062
Practice Address - Fax:972-665-6557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-21
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain