Basic Information
| Provider Information | |||||||||
| NPI: | 1376205864 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMERICAN PAIN & WELLNESS PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1417 GABLES CT STE 201 | ||||||||
| Address2: | |||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750757648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4693265115 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5400 STATE HIGHWAY 121 STE 100 | ||||||||
| Address2: | |||||||||
| City: | COLLEYVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760345929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174791500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2021 | ||||||||
| LastUpdateDate: | 10/14/2021 | ||||||||
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| AuthorizedOfficialLastName: | KRETZ | ||||||||
| AuthorizedOfficialFirstName: | SHIRLEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | AUTHORIZED ADMIN | ||||||||
| AuthorizedOfficialTelephone: | 4693265115 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | AMERICAN PAIN AND WELLNESS, PA | ||||||||
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| NPICertificationDate: | 10/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.