Provider Demographics
NPI:1669420345
Name:ALLIED PAIN MANAGEMENT CLINIC, P.A.
Entity type:Organization
Organization Name:ALLIED PAIN MANAGEMENT CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER RELATIONS
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:BLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-595-6078
Mailing Address - Street 1:PO BOX 131567
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75713-1567
Mailing Address - Country:US
Mailing Address - Phone:903-595-6078
Mailing Address - Fax:903-509-2545
Practice Address - Street 1:5201 S BROADWAY AVE
Practice Address - Street 2:STE 200
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-3748
Practice Address - Country:US
Practice Address - Phone:903-595-6078
Practice Address - Fax:903-509-2545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4166208VP0000X
TX302391041C0700X
TXDC5099111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Not Answered111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00861YMedicare ID - Type Unspecified