Basic Information
| Provider Information | |||||||||
| NPI: | 1649678889 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTEGRATED CENTERS OF PAIN MANAGEMENT LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9720 COIT RD | ||||||||
| Address2: | SUITE 220 # 338 | ||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750255833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4696561394 | ||||||||
| FaxNumber: | 8887706360 | ||||||||
| Practice Location | |||||||||
| Address1: | 6850 TPC DR | ||||||||
| Address2: | SUITE 116 | ||||||||
| City: | MCKINNEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750703145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4696561394 | ||||||||
| FaxNumber: | 8887706360 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2014 | ||||||||
| LastUpdateDate: | 12/19/2014 | ||||||||
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| AuthorizedOfficialLastName: | YOUNAS | ||||||||
| AuthorizedOfficialFirstName: | BABER | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 4696561394 | ||||||||
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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 | 208VP0000X | M9757 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
No ID Information.