Provider Demographics
NPI:1588146799
Name:VERTEX ADVANCED PAIN MANAGEMENT AND SPINE SPECIALIST PLLC
Entity type:Organization
Organization Name:VERTEX ADVANCED PAIN MANAGEMENT AND SPINE SPECIALIST PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:M
Authorized Official - Last Name:GANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-224-9101
Mailing Address - Street 1:4447 N CENTRAL EXPY STE 110-264
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205
Mailing Address - Country:US
Mailing Address - Phone:214-707-3634
Mailing Address - Fax:214-292-9332
Practice Address - Street 1:1325 PENNSYLVANIA AVE STE 300
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2110
Practice Address - Country:US
Practice Address - Phone:912-210-7779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-04
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty