Provider Demographics
NPI:1659189983
Name:TEXARKANA PAIN INSTITUTE
Entity type:Organization
Organization Name:TEXARKANA PAIN INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:WAGES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-773-9776
Mailing Address - Street 1:PO BOX 884
Mailing Address - Street 2:
Mailing Address - City:NASH
Mailing Address - State:TX
Mailing Address - Zip Code:75569-0884
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4102 GIBSON LN
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-1120
Practice Address - Country:US
Practice Address - Phone:903-461-7215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty