Healthcare Provider Details

I. General information

NPI: 1659088367
Provider Name (Legal Business Name): ELM PAIN INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2022
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8616 GREENVILLE AVE STE 101
DALLAS TX
75243-7166
US

IV. Provider business mailing address

8616 GREENVILLE AVE STE 101
DALLAS TX
75243-7166
US

V. Phone/Fax

Practice location:
  • Phone: 214-450-9926
  • Fax:
Mailing address:
  • Phone: 214-450-9926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS JEFFERSON
Title or Position: BILLING MANANGER
Credential:
Phone: 214-977-6357