Healthcare Provider Details

I. General information

NPI: 1346235967
Provider Name (Legal Business Name): LONE STAR PAIN INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 11/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 EAST EUREKA STREET SUITE B
WEATHERFORD TX
76086-5866
US

IV. Provider business mailing address

907 EAST EUREKA STREET SUITE B
WEATHERFORD TX
76086
US

V. Phone/Fax

Practice location:
  • Phone: 817-599-4901
  • Fax: 817-599-4902
Mailing address:
  • Phone: 817-599-4901
  • Fax: 817-599-4902

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. CHRIS OTTE
Title or Position: BUSINESS DIRECTOR
Credential:
Phone: 817-599-4901