=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851747018
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TEXAS PAIN CONSULTANTS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/06/2016
-----------------------------------------------------
Last Update Date | 04/03/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1000 W STATE HIGHWAY 6 STE 220
-----------------------------------------------------
City | WACO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76712-3788
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-307-2707
-----------------------------------------------------
Fax | 254-307-2709
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1000 W STATE HIGHWAY 6 STE 220
-----------------------------------------------------
City | WACO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76712-3788
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-307-2707
-----------------------------------------------------
Fax | 254-307-2709
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DAVID MARTINCHECK
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 254-307-2707
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208VP0000X
-----------------------------------------------------
Taxonomy Name | Pain Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------