MEDICARE: INCLUSIVE PAIN MANAGEMENT SPECIALISTS 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	261QH0100X	Health Service Clinic/Center	N4873	TX
2	208VP0000X	Pain Medicine Physician	N4873	TX
3	207R00000X	Internal Medicine Physician	N4873	TX

General Provider Information

NPI Number	:	1316244205
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INCLUSIVE PAIN MANAGEMENT SPECIALISTS PLLC

Provider Business Mailing Address
First Line	:	630 N BISHOP AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-4335
Country	:	US
Telephone Number	:	214-942-5673
Fax Number	:

Provider Business Practice Location Address
First Line	:	630 N BISHOP AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-4335
Country	:	US
Telephone Number	:	214-942-5673
Fax Number	:

Authorized Official
Title or Position	:	CHAIRMAN/PRESIDENT
Name	:	DR. ROBERT ABBATE
Credential	:	D.O.
Telephone Number	:	713-900-7246

Provider Enumeration Date	:	02/11/2011
Last Update Date	:	09/08/2011

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