1881274280 NPI number — ATX360 PHYSICIANS FOR PAIN MANAGEMENT, 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 1881274280 NPI number — ATX360 PHYSICIANS FOR PAIN MANAGEMENT, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATX360 PHYSICIANS FOR PAIN MANAGEMENT, 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:
1881274280
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
511 OAKWOOD BLVD STE 200
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:
78681-4068
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-734-8060
Provider Business Mailing Address Fax Number:
512-859-6684

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7700 CAT HOLLOW DR STE 203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROUND ROCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78681-5799
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-734-8060
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/09/2021

Additional Information

Authorized Official

Authorized Official Last Name:
PULIKAL
Authorized Official First Name:
ADITYA
Authorized Official Middle Name:
B
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
512-734-8060

Provider Taxonomy Codes

  • Taxonomy code: 2084P2900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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