Provider Demographics
NPI:1942299441
Name:PAIN CARE OF NORTH TEXAS, LLC
Entity type:Organization
Organization Name:PAIN CARE OF NORTH TEXAS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MELELEU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-817-4225
Mailing Address - Street 1:1111 RAINTREE CIRCLE
Mailing Address - Street 2:STE 190
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-4901
Mailing Address - Country:US
Mailing Address - Phone:214-509-9530
Mailing Address - Fax:214-509-0240
Practice Address - Street 1:1111 RAINTREE CIR
Practice Address - Street 2:SUITE 190
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-4901
Practice Address - Country:US
Practice Address - Phone:214-509-9530
Practice Address - Fax:214-509-0240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008093261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX008093OtherTX DEPT OF HEALTH
TX008093OtherTX DEPT OF HEALTH
TXASC218Medicare PIN