Healthcare Provider Details

I. General information

NPI: 1760701809
Provider Name (Legal Business Name): 360 PAIN AND REHABILITATION PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2010
Last Update Date: 04/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 PARK BEND DR BLGD 1, SUITE 201
AUSTIN TX
78758-5387
US

IV. Provider business mailing address

PO BOX 9135
CORPUS CHRISTI TX
78469-9135
US

V. Phone/Fax

Practice location:
  • Phone: 512-368-2200
  • Fax: 512-363-2201
Mailing address:
  • Phone: 512-368-2200
  • Fax: 512-363-2201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. MORGAN B KRULL
Title or Position: BILLING MANAGER
Credential:
Phone: 512-363-5779