Provider Demographics
NPI:1548285000
Name:PAIN SPECIALISTS OF TEXAS, LP
Entity type:Organization
Organization Name:PAIN SPECIALISTS OF TEXAS, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-606-8980
Mailing Address - Street 1:1759 BROAD PARK CIRCLE STREET SOUTH
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063
Mailing Address - Country:US
Mailing Address - Phone:682-518-0682
Mailing Address - Fax:682-518-1334
Practice Address - Street 1:1759 BROAD PARK CIRCLE STREET SOUTH
Practice Address - Street 2:SUITE 101
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:75052-3073
Practice Address - Country:US
Practice Address - Phone:682-518-0682
Practice Address - Fax:682-518-1334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5075,K3744261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0093NJOtherBCBS GROUP NUMBER
TX00W462Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER