Provider Demographics
NPI:1316312317
Name:PHYSICIAN PAIN CARE ASSOCIATES
Entity type:Organization
Organization Name:PHYSICIAN PAIN CARE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-391-2653
Mailing Address - Street 1:319 S 1ST ST STE 16
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76504-5500
Mailing Address - Country:US
Mailing Address - Phone:254-300-8339
Mailing Address - Fax:844-214-2393
Practice Address - Street 1:319 S 1ST ST STE 16
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-5500
Practice Address - Country:US
Practice Address - Phone:254-300-8339
Practice Address - Fax:844-214-2393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty