MEDICARE: UNITED PAIN PLLC

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	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1174106108
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNITED PAIN PLLC

Provider Business Mailing Address
First Line	:	12345 N LAMAR BLVD STE 137
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78753-1338
Country	:	US
Telephone Number	:	512-215-3256
Fax Number	:	512-339-2239

Provider Business Practice Location Address
First Line	:	12345 N LAMAR BLVD STE 137
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78753-1338
Country	:	US
Telephone Number	:	512-215-3256
Fax Number	:	512-339-2239

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROY ALLEN LOGAN
Credential	:	DC
Telephone Number	:	512-215-3256

Provider Enumeration Date	:	04/28/2021
Last Update Date	:	04/28/2021

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