Basic Information
| Provider Information | |||||||||
| NPI: | 1225554165 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHWEST JOINT PAIN MANAGEMENT, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2452 LAKEWOOD DR | ||||||||
| Address2: | |||||||||
| City: | GRAND PRAIRIE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750546800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727432126 | ||||||||
| FaxNumber: | 2149882082 | ||||||||
| Practice Location | |||||||||
| Address1: | 8611 HILLCREST RD, SUITE 245D | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727432126 | ||||||||
| FaxNumber: | 2149882082 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2017 | ||||||||
| LastUpdateDate: | 07/15/2019 | ||||||||
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| AuthorizedOfficialLastName: | HOWINGTON | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | MICHAEL | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9727432126 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CRNA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 70862 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.