1669420345 NPI number — ALLIED PAIN MANAGEMENT CLINIC, P.A.

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 1669420345 NPI number — ALLIED PAIN MANAGEMENT CLINIC, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLIED PAIN MANAGEMENT CLINIC, P.A.
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:
1669420345
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 131567
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TYLER
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75713-1567
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-595-6078
Provider Business Mailing Address Fax Number:
903-509-2545

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5201 S BROADWAY AVE
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
TYLER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75703-3748
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-595-6078
Provider Business Practice Location Address Fax Number:
903-509-2545
Provider Enumeration Date:
05/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BLANTON
Authorized Official First Name:
AMY
Authorized Official Middle Name:
JO
Authorized Official Title or Position:
PROVIDER RELATIONS
Authorized Official Telephone Number:
903-595-6078

Provider Taxonomy Codes

  • Taxonomy code: 208VP0000X , with the licence number:  H4166 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 30239 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111NX0800X , with the licence number: DC5099 , 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)





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