Provider Demographics
NPI:1528939360
Name:PILOTSPAN LLC
Entity type:Organization
Organization Name:PILOTSPAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:IKHILAE
Authorized Official - Suffix:
Authorized Official - Credentials:MANAGING PARTNER
Authorized Official - Phone:806-810-4030
Mailing Address - Street 1:3010 LBJ FWY STE 1223
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-7770
Mailing Address - Country:US
Mailing Address - Phone:806-810-4030
Mailing Address - Fax:
Practice Address - Street 1:3010 LBJ FWY STE 1223
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-7770
Practice Address - Country:US
Practice Address - Phone:806-301-2070
Practice Address - Fax:806-810-4060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-15
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty