Provider Demographics
NPI:1053526343
Name:PAIN MANAGEMENT CONSULTANTS, PA
Entity type:Organization
Organization Name:PAIN MANAGEMENT CONSULTANTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-406-0158
Mailing Address - Street 1:101 W KOENIG LN
Mailing Address - Street 2:STE 100
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-1213
Mailing Address - Country:US
Mailing Address - Phone:512-454-9426
Mailing Address - Fax:512-454-7294
Practice Address - Street 1:101 W KOENIG LN
Practice Address - Street 2:STE 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-1213
Practice Address - Country:US
Practice Address - Phone:512-454-9426
Practice Address - Fax:512-454-7294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00L32SMedicare ID - Type Unspecified