Provider Demographics
NPI:1215352331
Name:PREMIER PAIN CONSULTANTS, PLLC
Entity type:Organization
Organization Name:PREMIER PAIN CONSULTANTS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEKSEI
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-298-9000
Mailing Address - Street 1:2425 BABCOCK RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4898
Mailing Address - Country:US
Mailing Address - Phone:210-298-9000
Mailing Address - Fax:210-298-9001
Practice Address - Street 1:2425 BABCOCK RD
Practice Address - Street 2:SUITE 108A
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4898
Practice Address - Country:US
Practice Address - Phone:210-298-9000
Practice Address - Fax:210-298-9001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-26
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX290483336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy