Provider Demographics
NPI:1174903975
Name:OMNI SPINE PAIN MANAGEMENT, PLLC
Entity type:Organization
Organization Name:OMNI SPINE PAIN MANAGEMENT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:MORCHOWER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-705-1200
Mailing Address - Street 1:8380 WARREN PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-4199
Mailing Address - Country:US
Mailing Address - Phone:214-705-1200
Mailing Address - Fax:214-705-1201
Practice Address - Street 1:8380 WARREN PKWY STE 100
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4199
Practice Address - Country:US
Practice Address - Phone:214-705-1200
Practice Address - Fax:214-705-1201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-05
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM1300X
TXN1784208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty