=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649510215
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTH TEXAS PAIN SPECIALISTS, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/19/2013
-----------------------------------------------------
Last Update Date | 02/21/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2455 NE LOOP 410 SUITE 249
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78217-5649
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-236-5558
-----------------------------------------------------
Fax | 210-236-7251
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2455 NE LOOP 410 SUITE 249
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78217-5649
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-236-5558
-----------------------------------------------------
Fax | 210-236-7251
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | DR. SHYAM PURSWANI
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 210-236-5558
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2081P2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number | K1005
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------