Provider Demographics
NPI:1811073810
Name:PAIN TREATMENT CLINICS PA
Entity type:Organization
Organization Name:PAIN TREATMENT CLINICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ISABEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:ANYANWU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-708-9393
Mailing Address - Street 1:2105 W SPRINGCREEK PKWY
Mailing Address - Street 2:SUITE 349-120
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023
Mailing Address - Country:US
Mailing Address - Phone:972-708-9393
Mailing Address - Fax:
Practice Address - Street 1:2929 S HAMPTON RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224
Practice Address - Country:US
Practice Address - Phone:972-708-9393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5653261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherTAX ID