MEDICARE: PAIN MANAGEMENT CONSULTANTS, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208VP0014X	Interventional Pain Medicine Physician

General Provider Information

NPI Number	:	1053526343
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAIN MANAGEMENT CONSULTANTS, PA

Provider Business Mailing Address
First Line	:	101 W KOENIG LN
Second Line	:	STE 100
City	:	AUSTIN
State	:	TX
Zip	:	78751-1213
Country	:	US
Telephone Number	:	512-454-9426
Fax Number	:	512-454-7294

Provider Business Practice Location Address
First Line	:	101 W KOENIG LN
Second Line	:	STE 100
City	:	AUSTIN
State	:	TX
Zip	:	78751-1213
Country	:	US
Telephone Number	:	512-454-9426
Fax Number	:	512-454-7294

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. JOEL HARO
Credential	:
Telephone Number	:	512-406-0158

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	09/07/2012

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