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General NPI Number Information
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NPI Number | 1184381196
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Entity Type | Organization
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Legal Business Name | CARDINAL INTERVENTIONAL PAIN CLINIC PLLC
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Dates
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Enumeration Date | 11/24/2021
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Last Update Date | 02/04/2022
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Provider Practice Location Address
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Address Line | 2717 SUMMERHILL RD
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City | TEXARKANA
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State | TX
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Zip | 75503-3957
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Country | US
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Telephone | 214-642-2943
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Fax | 877-540-9887
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Provider Business Mailing Address
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Address Line | 6501 LAKEVIEW DR
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City | TEXARKANA
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State | TX
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Zip | 75503-1906
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ACOUNT MANAGER
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Name | SUSAN SIMON
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Credential |
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Telephone | 214-642-2943
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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