Provider Demographics
NPI:1386786564
Name:SOUTHWESTERN PAIN INSTITUTE, PA
Entity type:Organization
Organization Name:SOUTHWESTERN PAIN INSTITUTE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PAIN MANAGEMENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHALEV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-980-4400
Mailing Address - Street 1:PO BOX 803311
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75380-3311
Mailing Address - Country:US
Mailing Address - Phone:972-980-4400
Mailing Address - Fax:972-980-4100
Practice Address - Street 1:5744 LYNDON B JOHNSON FWY
Practice Address - Street 2:SUITE 175
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-6322
Practice Address - Country:US
Practice Address - Phone:972-980-4400
Practice Address - Fax:972-980-4100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0021DMOtherBLUE CROSS BLUE SHIELD
TX00058NMedicare ID - Type UnspecifiedGROUP NUMBER