MEDICARE: PAIN MANAGEMENT HOLDINGS, 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	261QP3300X	Pain Clinic/Center

General Provider Information

NPI Number	:	1649450511
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAIN MANAGEMENT HOLDINGS, PA

Provider Business Mailing Address
First Line	:	PO BOX 831655
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75083-1655
Country	:	US
Telephone Number	:	214-317-4666
Fax Number	:	214-317-4667

Provider Business Practice Location Address
First Line	:	4040 N MACARTHUR BLVD
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75038-6413
Country	:	US
Telephone Number	:	214-317-4666
Fax Number	:	214-317-4667

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MIKE SHAH
Credential	:	M.D.
Telephone Number	:	214-317-4666

Provider Enumeration Date	:	11/08/2007
Last Update Date	:	11/08/2007

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