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General NPI Number Information
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NPI Number | 1659189983
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Entity Type | Organization
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Legal Business Name | TEXARKANA PAIN INSTITUTE
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Dates
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Enumeration Date | 12/19/2024
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Last Update Date | 12/19/2024
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Provider Practice Location Address
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Address Line | 4102 GIBSON LN
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City | TEXARKANA
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State | TX
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Zip | 75503-1120
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Country | US
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Telephone | 903-461-7215
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 884
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City | NASH
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State | TX
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Zip | 75569-0884
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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 | OWNER
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Name | JAMES MICHAEL WAGES
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Credential | MD
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Telephone | 214-773-9776
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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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