Provider Demographics
NPI:1164827507
Name:PAIN ASSOCIATES OF LONGVIEW PLLC
Entity type:Organization
Organization Name:PAIN ASSOCIATES OF LONGVIEW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAJASHEKAR
Authorized Official - Middle Name:R
Authorized Official - Last Name:LAKKADI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-331-0506
Mailing Address - Street 1:PO BOX 2922
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75606-2922
Mailing Address - Country:US
Mailing Address - Phone:903-331-0506
Mailing Address - Fax:903-331-0462
Practice Address - Street 1:438 N FREDONIA ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-6468
Practice Address - Country:US
Practice Address - Phone:903-331-0506
Practice Address - Fax:903-331-0462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-28
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4849207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty