Provider Demographics
NPI:1811158843
Name:PYRAMID PAIN & REHAB P.A.
Entity type:Organization
Organization Name:PYRAMID PAIN & REHAB P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SREENADHA
Authorized Official - Middle Name:R
Authorized Official - Last Name:VATTAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-765-6978
Mailing Address - Street 1:6447 MALAGA
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-3191
Mailing Address - Country:US
Mailing Address - Phone:214-765-6978
Mailing Address - Fax:
Practice Address - Street 1:3500 INTERSTATE 30
Practice Address - Street 2:BUILDING D, SUITE # 203
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-2696
Practice Address - Country:US
Practice Address - Phone:214-765-6978
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM28512081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty