Provider Demographics
NPI:1720441538
Name:OMNI SPINE PAIN MANAGEMENT, PLLC
Entity Type:Organization
Organization Name:OMNI SPINE PAIN MANAGEMENT, PLLC
Other - Org Name:OMNI SPINE PAIN MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING DEPARTMENT
Authorized Official - Prefix:MS
Authorized Official - First Name:WHITNEY
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-645-1260
Mailing Address - Street 1:8380 WARREN PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-4199
Mailing Address - Country:US
Mailing Address - Phone:214-705-1200
Mailing Address - Fax:214-705-1201
Practice Address - Street 1:6243 RETAIL RD STE 500
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-7867
Practice Address - Country:US
Practice Address - Phone:214-705-1200
Practice Address - Fax:214-705-1201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-30
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN17842081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXN1784OtherSTATE LICENSE NUMBER