Basic Information
| Provider Information | |||||||||
| NPI: | 1215547823 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PAIN MANAGEMENT OF NORTH TEXAS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4760 PRESTON RD STE 244-412 | ||||||||
| Address2: | |||||||||
| City: | FRISCO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750348548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146180853 | ||||||||
| FaxNumber: | 2146180859 | ||||||||
| Practice Location | |||||||||
| Address1: | 2024 W HIGHWAY 82 | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 762402051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146180853 | ||||||||
| FaxNumber: | 2146180859 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2020 | ||||||||
| LastUpdateDate: | 08/18/2022 | ||||||||
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| AuthorizedOfficialLastName: | HAQ | ||||||||
| AuthorizedOfficialFirstName: | ADEEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8129891976 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 08/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
No ID Information.