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General NPI Number Information
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NPI Number | 1124508841
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Entity Type | Organization
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Legal Business Name | AUSTIN INTERVENTIONAL PAIN AND WELLNESS
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Dates
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Enumeration Date | 08/21/2018
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Last Update Date | 01/22/2020
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Provider Practice Location Address
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Address Line | 1900 SCENIC DR STE 1108
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City | GEORGETOWN
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State | TX
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Zip | 78626-7724
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Country | US
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Telephone | 512-400-4195
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Fax | 512-287-5563
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Provider Business Mailing Address
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Address Line | PO BOX 674029
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City | DALLAS
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State | TX
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Zip | 75267-4029
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Country | US
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Telephone | 512-400-4195
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Fax | 512-287-5563
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Authorized Official
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Title or Position | MD
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Name | DEVIN PECK
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Credential |
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Telephone | 972-503-6863
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) 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 | 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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