Healthcare Provider Details

I. General information

NPI: 1710280326
Provider Name (Legal Business Name): PREMIER PAIN CONSULTANTS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2010
Last Update Date: 12/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18626 HARDY OAK SUITE 215
SAN ANTONIO TX
78258
US

IV. Provider business mailing address

PO BOX 26
SAN ANTONIO TX
78291
US

V. Phone/Fax

Practice location:
  • Phone: 210-616-9400
  • Fax: 210-616-9404
Mailing address:
  • Phone: 210-616-9400
  • Fax: 210-616-9402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberM2907
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberN3706
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberL7996
License Number StateTX

VIII. Authorized Official

Name: MR. YURII D BORSHCH
Title or Position: GENERAL PARTNER
Credential: M.D.
Phone: 210-616-9400