Provider Demographics
NPI:1124131040
Name:MEDICAL BIOFEEDBACK & PAIN CONTROL CENTER
Entity type:Organization
Organization Name:MEDICAL BIOFEEDBACK & PAIN CONTROL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANIS
Authorized Official - Middle Name:
Authorized Official - Last Name:WILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-369-8717
Mailing Address - Street 1:7515 GREENVILLE AVE STE 1005
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-3805
Mailing Address - Country:US
Mailing Address - Phone:214-369-8717
Mailing Address - Fax:214-369-7937
Practice Address - Street 1:7515 GREENVILLE AVE STE 1005
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3805
Practice Address - Country:US
Practice Address - Phone:214-369-8717
Practice Address - Fax:214-369-7937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7536101YP2500X
TXMD M0311207Q00000X
TXH7354207Q00000X
TXH0800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K0231OtherBCBS PROVIDER ID
TXI26963Medicare UPIN
TXB88252Medicare UPIN