Provider Demographics
NPI:1538393665
Name:COMPREHENSIVE INTERVENTIONAL PAIN PROCEDURE CENTER
Entity type:Organization
Organization Name:COMPREHENSIVE INTERVENTIONAL PAIN PROCEDURE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TED
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSBECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-362-6909
Mailing Address - Street 1:7920 BELT LINE RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-8145
Mailing Address - Country:US
Mailing Address - Phone:972-234-4740
Mailing Address - Fax:
Practice Address - Street 1:4103 SWISS AVE STE B
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-8102
Practice Address - Country:US
Practice Address - Phone:972-234-4740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-04
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain