1548303985 NPI number — CAPITOL PAIN INSTITUTE

Table of content: (NPI 1548303985)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548303985 NPI number — CAPITOL PAIN INSTITUTE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAPITOL PAIN INSTITUTE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548303985
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7951 SHOAL CREEK BLVD STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78757-7582
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-584-8404
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8015 SHOAL CREEK BLVD STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78757
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-467-7246
Provider Business Practice Location Address Fax Number:
512-467-7247
Provider Enumeration Date:
02/15/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SCHOCKET
Authorized Official First Name:
SANDFORD
Authorized Official Middle Name:
MATTHEW
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
512-467-7246

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2081P2900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)