1639696016 NPI number — HEALTH AND PAIN MEDICINE INSTITUTE, P.A.

Table of content: (NPI 1639696016)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639696016 NPI number — HEALTH AND PAIN MEDICINE INSTITUTE, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTH AND PAIN MEDICINE INSTITUTE, 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:
1639696016
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/25/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3900 TELEPORT BLVD UNIT 143361
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRVING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75014-0239
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-489-7652
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1700 PACIFIC AVE STE 260
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75201-7478
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-489-7652
Provider Business Practice Location Address Fax Number:
877-778-5117
Provider Enumeration Date:
08/25/2017

Additional Information

Authorized Official

Authorized Official Last Name:
OLAMIKAN
Authorized Official First Name:
OLUWASOLA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
503-489-7652

Provider Taxonomy Codes

  • Taxonomy code: 207LP3000X , with the licence number:  P1378 , 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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