Basic Information
| Provider Information | |||||||||
| NPI: | 1346519212 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MIDTOWN INTERVENTIONAL PAIN CENTER LLD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 674231 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752674231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724791115 | ||||||||
| FaxNumber: | 9723468015 | ||||||||
| Practice Location | |||||||||
| Address1: | 911 W ANDERSON LN | ||||||||
| Address2: | STE 104 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787571501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124671100 | ||||||||
| FaxNumber: | 5126471101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2011 | ||||||||
| LastUpdateDate: | 12/22/2011 | ||||||||
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| AuthorizedOfficialLastName: | GROSBECK | ||||||||
| AuthorizedOfficialFirstName: | TED | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4693626909 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP3300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Pain |
No ID Information.