1174955058 NPI number — DALLAS SENSORY PAIN CLINIC PHYSICIANS, PLLC

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 1174955058 NPI number — DALLAS SENSORY PAIN CLINIC PHYSICIANS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DALLAS SENSORY PAIN CLINIC PHYSICIANS, PLLC
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:
1174955058
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3308 PRESTON RD
Provider Second Line Business Mailing Address:
STE 350-287
Provider Business Mailing Address City Name:
PLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75093-5979
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-372-4675
Provider Business Mailing Address Fax Number:
866-521-1985

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3308 PRESTON RD
Provider Second Line Business Practice Location Address:
STE 350-287
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75093-5979
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-372-4675
Provider Business Practice Location Address Fax Number:
866-521-1985
Provider Enumeration Date:
08/02/2013

Additional Information

Authorized Official

Authorized Official Last Name:
ISAAC
Authorized Official First Name:
SANJAI
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
214-471-5968

Provider Taxonomy Codes

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

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





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