1720419617 NPI number — BALCONES PAIN CONSULTANTS

Table of content: (NPI 1720419617)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720419617 NPI number — BALCONES PAIN CONSULTANTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BALCONES 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:
1720419617
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/03/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4544 S LAMAR BLVD
Provider Second Line Business Mailing Address:
SUITE 700
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78745-1500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-834-4141
Provider Business Mailing Address Fax Number:
512-834-4142

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
181 CIMARRON PARK LOOP
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
BUDA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78610-2852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-834-4141
Provider Business Practice Location Address Fax Number:
512-834-4142
Provider Enumeration Date:
12/03/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LOWRY
Authorized Official First Name:
ANGUS
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT/SECRETARY
Authorized Official Telephone Number:
512-834-4141

Provider Taxonomy Codes

  • Taxonomy code: 208VP0014X , with the licence number:  L9787 , 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)