Provider Demographics
NPI:1912120841
Name:PREMIER PAIN CARE PA
Entity Type:Organization
Organization Name:PREMIER PAIN CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:J
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-323-9404
Mailing Address - Street 1:PO BOX 50689
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76206-0689
Mailing Address - Country:US
Mailing Address - Phone:940-323-9404
Mailing Address - Fax:940-323-9422
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:940-323-9422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2060208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0083HQOtherBCBS GROUP NUMBER
TX00365TMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
TX6498300001Medicare NSC