Basic Information
| Provider Information | |||||||||
| NPI: | 1164043279 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PAIN MANAGEMENT PHYSICIANS OF DALLAS, PLLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | DALLAS PAIN CONSULTANTS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1411 N BECKLEY AVE STE 152 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752031586 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2149487700 | ||||||||
| FaxNumber: | 2149487701 | ||||||||
| Practice Location | |||||||||
| Address1: | 8080 HWY 121 SUITE 210 | ||||||||
| Address2: | |||||||||
| City: | MCKINNEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750707894 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2149487700 | ||||||||
| FaxNumber: | 2149487701 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2020 | ||||||||
| LastUpdateDate: | 05/19/2021 | ||||||||
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| AuthorizedOfficialLastName: | KRAUS | ||||||||
| AuthorizedOfficialFirstName: | TREVOR | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 2149487700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PAIN MANAGEMENT PHYSICIANS OF DALLAS, PLLC | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 04/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0014X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
No ID Information.