Provider Demographics
NPI:1023307402
Name:PREMIER PAIN CONSULTANTS, PA
Entity type:Organization
Organization Name:PREMIER PAIN CONSULTANTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIAL COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ILLIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GALVAN-COBOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-616-9400
Mailing Address - Street 1:PO BOX 26
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78291
Mailing Address - Country:US
Mailing Address - Phone:210-616-9400
Mailing Address - Fax:210-616-9402
Practice Address - Street 1:1650 LOCKHILL SELMA RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-1929
Practice Address - Country:US
Practice Address - Phone:210-616-9400
Practice Address - Fax:210-616-9402
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER PAIN CONSULTANTS, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN3706207LP2900X
TXM2907207LP2900X
TXL7996207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty