Provider Demographics
NPI:1982806204
Name:SUMMIT SPECIALISTS OF PAIN, PLLC
Entity type:Organization
Organization Name:SUMMIT SPECIALISTS OF PAIN, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD/CEO
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:W
Authorized Official - Last Name:WHISENANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:945-766-4467
Mailing Address - Street 1:2931 RIDGE RD STE 101-159
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-6670
Mailing Address - Country:US
Mailing Address - Phone:972-741-5953
Mailing Address - Fax:972-777-9939
Practice Address - Street 1:4000 WESLEY ST STE D
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-9015
Practice Address - Country:US
Practice Address - Phone:945-766-4467
Practice Address - Fax:972-777-9939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2024-09-03
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
TX395576OtherWELLCARE
TX075PSOtherBCBS/TX
TX00Z758Medicare PIN