Provider Demographics
NPI:1982806204
Name:SUMMITT SPECIALISTS OF PAIN LLC
Entity Type:Organization
Organization Name:SUMMITT SPECIALISTS OF PAIN LLC
Other - Org Name:SUMMIT SPECIALISTS OF PAIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:WHISENANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-276-6300
Mailing Address - Street 1:8301 LAKEVIEW PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-9320
Mailing Address - Country:US
Mailing Address - Phone:972-276-6300
Mailing Address - Fax:972-862-1085
Practice Address - Street 1:8301 LAKEVIEW PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-9320
Practice Address - Country:US
Practice Address - Phone:972-276-6300
Practice Address - Fax:972-862-1085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7725207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX075PSOtherBCBS/TX
TX00Z760Medicare PIN
TX00Z758Medicare PIN