Basic Information
| Provider Information | |||||||||
| NPI: | 1629506357 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VANGUARD PAIN MANAGEMENT, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 HIGHLANDER BLVD STE 415 | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760154346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173301102 | ||||||||
| FaxNumber: | 8175168444 | ||||||||
| Practice Location | |||||||||
| Address1: | 9080 HARRY HINES BLVD STE 110 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752351700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146370887 | ||||||||
| FaxNumber: | 2146370886 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2017 | ||||||||
| LastUpdateDate: | 05/25/2017 | ||||||||
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| AuthorizedOfficialLastName: | KIM | ||||||||
| AuthorizedOfficialFirstName: | BENJAMIN | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | SOLE MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 8175168811 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.