Healthcare Provider Details

I. General information

NPI: 1053526343
Provider Name (Legal Business Name): PAIN MANAGEMENT CONSULTANTS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 09/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W KOENIG LN STE 100
AUSTIN TX
78751-1213
US

IV. Provider business mailing address

101 W KOENIG LN STE 100
AUSTIN TX
78751-1213
US

V. Phone/Fax

Practice location:
  • Phone: 512-454-9426
  • Fax: 512-454-7294
Mailing address:
  • Phone: 512-454-9426
  • Fax: 512-454-7294

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: MR. JOEL HARO
Title or Position: ADMINISTRATOR
Credential:
Phone: 512-406-0158