1255523676 NPI number — VITAL PAIN CONSULTANTS

Table of content: (NPI 1255523676)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255523676 NPI number — VITAL PAIN CONSULTANTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VITAL PAIN CONSULTANTS
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:
1255523676
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5920 FOREST PARK RD
Provider Second Line Business Mailing Address:
SUITE 700
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75235-6411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-350-2400
Provider Business Mailing Address Fax Number:
214-352-4862

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5920 FOREST PARK RD
Provider Second Line Business Practice Location Address:
SUITE 700
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75235-6411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-350-2400
Provider Business Practice Location Address Fax Number:
214-352-4862
Provider Enumeration Date:
08/10/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BURTON
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS OFFICE SUPERVISOR
Authorized Official Telephone Number:
214-350-2400

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  008323 , 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)