1518426691 NPI number — NORTH DALLAS PAIN MANAGEMENT CENTER, P.A.

Table of content: (NPI 1518426691)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518426691 NPI number — NORTH DALLAS PAIN MANAGEMENT CENTER, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH DALLAS PAIN MANAGEMENT CENTER, 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:
1518426691
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6505 W PARK BLVD
Provider Second Line Business Mailing Address:
STE 306 PMB 376
Provider Business Mailing Address City Name:
PLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75093-6212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-316-3344
Provider Business Mailing Address Fax Number:
972-316-3322

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
825 W ROYAL LN STE 230
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IRVING
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75039-3901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-956-5541
Provider Business Practice Location Address Fax Number:
469-730-2192
Provider Enumeration Date:
03/18/2019

Additional Information

Authorized Official

Authorized Official Last Name:
TARIQ
Authorized Official First Name:
MOHAMMAD
Authorized Official Middle Name:
JAVED
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
972-316-3344

Provider Taxonomy Codes

  • 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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