Healthcare Provider Details

I. General information

NPI: 1407229479
Provider Name (Legal Business Name): NSA PAIN SERVICES OF MICHIGAN, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2015
Last Update Date: 05/25/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6225 N STATE HIGHWAY 161 STE 200
IRVING TX
75038-2241
US

IV. Provider business mailing address

6225 N STATE HIGHWAY 161 STE 200
IRVING TX
75038-2241
US

V. Phone/Fax

Practice location:
  • Phone: 214-687-0001
  • Fax: 972-518-2100
Mailing address:
  • Phone: 239-610-0775
  • Fax:

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: MR. KEITH A HALL
Title or Position: CREDENTIALING MANAGER
Credential: CPCS
Phone: 214-687-0496