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General NPI Number Information
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NPI Number | 1942674726
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Entity Type | Organization
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Legal Business Name | CENTRAL TEXAS PAIN INSTITUTE, PLLC
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Dates
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Enumeration Date | 11/17/2015
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Last Update Date | 04/25/2019
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Provider Practice Location Address
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Address Line | 1401 MEDICAL PKWY STE 345
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City | CEDAR PARK
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State | TX
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Zip | 78613-7763
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Country | US
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Telephone | 512-485-7200
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Fax | 512-485-7224
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Provider Business Mailing Address
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Address Line | PO BOX 733946
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City | DALLAS
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State | TX
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Zip | 75373-3946
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Country | US
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Telephone | 512-485-7200
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Fax | 512-485-7220
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | LORI FULLER
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Credential |
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Telephone | 512-485-7200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | J7566
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License Number State | TX
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