1598763245 NPI number — TEXAS PAIN REHABILITATION INSTITUTE, PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598763245 NPI number — TEXAS PAIN REHABILITATION INSTITUTE, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEXAS PAIN REHABILITATION INSTITUTE, PA
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:
TEXAS REHABILITATION INSTITUTE
Provider Other Organization Name Type Code:
3
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:
1598763245
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7200 WYOMING SPGS STE 400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROUND ROCK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78681-4304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-310-7246
Provider Business Mailing Address Fax Number:
512-310-7667

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7200 WYOMING SPGS
Provider Second Line Business Practice Location Address:
STE 400
Provider Business Practice Location Address City Name:
ROUND ROCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78681-4304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-310-7246
Provider Business Practice Location Address Fax Number:
512-310-7667
Provider Enumeration Date:
07/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
OWEN
Authorized Official First Name:
GRAVES
Authorized Official Middle Name:
T
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
512-310-7246

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com