Provider Demographics
NPI:1023227006
Name:NORTHTEXAS PAIN MANAGEMENT ASS
Entity type:Organization
Organization Name:NORTHTEXAS PAIN MANAGEMENT ASS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWMER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-345-5656
Mailing Address - Street 1:8220 WALNUT HILL LN STE 202
Mailing Address - Street 2:LB98
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4406
Mailing Address - Country:US
Mailing Address - Phone:214-345-5656
Mailing Address - Fax:214-345-5698
Practice Address - Street 1:8220 WALNUT HILL LN STE 202
Practice Address - Street 2:LB98
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4406
Practice Address - Country:US
Practice Address - Phone:214-345-5656
Practice Address - Fax:214-345-5698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXOOD71CMedicare ID - Type Unspecified