Provider Demographics
NPI:1871540971
Name:PAIN MANAGMENT JOINT VENTURE LLP
Entity type:Organization
Organization Name:PAIN MANAGMENT JOINT VENTURE LLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:LORREN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:903-753-6635
Mailing Address - Street 1:3202 N 4TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-5143
Mailing Address - Country:US
Mailing Address - Phone:903-753-6635
Mailing Address - Fax:903-236-3185
Practice Address - Street 1:3202 N 4TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-5143
Practice Address - Country:US
Practice Address - Phone:903-753-6635
Practice Address - Fax:903-236-3185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX650460000225100000X
TX5500600000225100000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0071BTOtherBLUE CROSS
TX021731701Medicaid
TX021731701Medicaid
TX4991010001Medicare NSC