Provider Demographics
NPI:1063655124
Name:PYRAMID PAIN AND REHAB P.A.
Entity type:Organization
Organization Name:PYRAMID PAIN AND REHAB P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:SREENADHA
Authorized Official - Middle Name:R
Authorized Official - Last Name:VATTAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-892-1999
Mailing Address - Street 1:1001 SARA SWAMY DR STE 220
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-3124
Mailing Address - Country:US
Mailing Address - Phone:903-892-1999
Mailing Address - Fax:903-892-6999
Practice Address - Street 1:1001 SARA SWAMY DR.
Practice Address - Street 2:STE 220
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-3124
Practice Address - Country:US
Practice Address - Phone:903-892-1999
Practice Address - Fax:903-892-6999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-19
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM28512081P2900X
TX2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6514340001OtherNSC
TXDP2969OtherRR MEDICARE
TXDP2969OtherRR MEDICARE