Provider Demographics
NPI:1104479146
Name:SHAW PAIN CLINIC PLLC
Entity type:Organization
Organization Name:SHAW PAIN CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROD
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-588-9230
Mailing Address - Street 1:503 FM 1431 EAST, SUITE 201
Mailing Address - Street 2:
Mailing Address - City:MARBLE FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:78654-5252
Mailing Address - Country:US
Mailing Address - Phone:830-220-5007
Mailing Address - Fax:830-220-5009
Practice Address - Street 1:503 FM 1431 EAST, SUITE 201
Practice Address - Street 2:
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78654-5252
Practice Address - Country:US
Practice Address - Phone:830-220-5007
Practice Address - Fax:830-220-5009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-18
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty