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General NPI Number Information
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NPI Number | 1902006729
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Entity Type | Organization
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Legal Business Name | PAIN MANAGEMENT HOLDINGS
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Dates
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Enumeration Date | 07/19/2007
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Last Update Date | 07/19/2007
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Provider Practice Location Address
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Address Line | 1001 PALM DESERT DR
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City | GARLAND
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State | TX
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Zip | 75044-5011
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Country | US
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Telephone | 617-504-4843
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 831655
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City | RICHARDSON
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State | TX
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Zip | 75083-1655
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Country | US
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Telephone | 617-504-4843
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRUGESHKUMAR KANAIYALAL SHAH
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Credential | MD
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Telephone | 617-504-4843
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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 | H8442
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License Number State | TX
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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 | L6174
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License Number State | TX
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