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General NPI Number Information
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NPI Number | 1013163179
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Entity Type | Organization
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Legal Business Name | PARK CENTRAL PAIN MEDICINE ASSOCIATES, PA
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Dates
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Enumeration Date | 08/08/2008
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Last Update Date | 01/27/2011
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Provider Practice Location Address
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Address Line | 3821 ROSS AVE
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City | DALLAS
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State | TX
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Zip | 75204-5245
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Country | US
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Telephone | 214-515-9300
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Fax | 214-515-9302
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Provider Business Mailing Address
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Address Line | 3821 ROSS AVE
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City | DALLAS
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State | TX
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Zip | 75204-5245
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Country | US
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Telephone | 214-515-9300
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Fax | 214-515-9302
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL D ANDERSON
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Credential | DC
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Telephone | 972-239-7246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 8788
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License Number State | TX
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