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General NPI Number Information
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NPI Number | 1902256233
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Entity Type | Organization
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Legal Business Name | COMMUNITY PAIN RELIEF CENTERS, PLLC
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Dates
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Enumeration Date | 06/17/2016
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Last Update Date | 06/17/2016
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Provider Practice Location Address
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Address Line | 11700 PRESTON RD STE 660-136
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City | DALLAS
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State | TX
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Zip | 75230-6112
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Country | US
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Telephone | 877-750-1027
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Fax | 877-750-1079
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Provider Business Mailing Address
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Address Line | 11700 PRESTON RD STE 660-136
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City | DALLAS
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State | TX
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Zip | 75230-6112
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Country | US
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Telephone | 877-750-1027
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Fax | 877-750-1079
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHNNY LEE WHITE JR.
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Credential | M.D.
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Telephone | 877-750-1027
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | G1581
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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