Healthcare Provider Details

I. General information

NPI: 1013472265
Provider Name (Legal Business Name): PREMIERE PAIN SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2019
Last Update Date: 03/08/2020
Certification Date: 03/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12309 N MOPAC EXPY STE 125
AUSTIN TX
78758-2577
US

IV. Provider business mailing address

12309 N MOPAC EXPY STE 125
AUSTIN TX
78758-2577
US

V. Phone/Fax

Practice location:
  • Phone: 512-206-8000
  • Fax:
Mailing address:
  • Phone: 512-206-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KRISTYN BILLINGS
Title or Position: INSURANCE DEPT
Credential:
Phone: 412-655-4362