PAIN & NEUROMUSCULAR CLINIC OF TEXAS , P.A. (NPI# 1275759540) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275759540 |
| Entity Type | Organization |
| Organization Name | PAIN & NEUROMUSCULAR CLINIC OF TEXAS , P.A. |
| Practice Address |
6100 Bandera Rd 710 San Antonio TX 78238-1652 |
| Mailing Address |
Po Box 29097 San Antonio TX 78229-0097 |
| Practice Telephone | 2108262311 |
| Practice Fax Number | 2108262641 |
| Mailing Telephone | 2108262311 |
| Mailing Fax Number | 2108262641 |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. SAMUEL MICHAEL THEAGENE (PRESIDENT) |
| Authorized Official Telephone | 2108262311 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | J7690 | TX | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | BLUE CROSS BLUE SHIELD | 0074DJ | 01 |
| Street Address |
6100 BANDERA RD 710 |
| City | SAN ANTONIO |
| State | TX |
| Zip Code | 78238-1652 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831182005 | Kathleen Jane Lyssy | Internal Medicine | 6100 Bandera Rd, 403, San Antonio, TX 78238-1652 | 2005-08-23 |
| 1205039559 | Kenneth M. Lyssy Jr Md Pa | Family Medicine | 6100 Bandera Rd, Suite 403, San Antonio, TX 78238-1652 | 2007-06-06 |
| 1316061377 | Carlos Javier Diaz Velez | Internal Medicine | 6100 Bandera Rd, Suite 215, San Antonio, TX 78238-1652 | 2007-03-16 |
| 1417086372 | Lawrence Paul Dimiceli | Dentist | 6100 Bandera Rd, Ste 300, San Antonio, TX 78238 | 2007-03-05 |
| 1831284892 | Praful R Mehta | Internal Medicine | 6100 Bandera Rd, Suite 710, San Antonio, TX 78238-1652 | 2006-10-04 |
| 1194718361 | Kenneth M Lyssy Jr. | Family Medicine | 6100 Bandera Rd, 403, San Antonio, TX 78238-1652 | 2005-08-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598383259 | Dialysis Clinic Inc. | Clinic/Center | 6146 Wurzbach Road, San Antonio, TX 78238 | 2020-07-09 |
| 1043857360 | Danielle Renee De Luna | Counselor | 5505 Lost Lane, San Antonio, TX 78238 | 2019-12-05 |
| 1013444777 | Avery Rodriguez | Physical Therapy Assistant | 5270 Bandera Rd Ste 14, San Antonio, TX 78238 | 2017-05-12 |
| 1760898894 | Silas Pimentel | Physical Therapist | 5720 Bandera Rd Ste 14, San Antonio, TX 78238 | 2014-07-09 |
| 1942550553 | Stanley Toh Forze | Registered Nurse | 6933 Border Brk Apt 1910, San Antonio, TX 78238 | 2012-09-12 |
| 1891004032 | Texan Smile Dentistry 3 PC | Dentist | 5983 Bandera Rd., San Antonio, TX 78238 | 2010-10-06 |
| 1275847683 | Deborah Michelle Solorzano | Dentist | 5715 Evers Road, San Antonio, TX 78238 | 2010-07-28 |
| 1932436326 | Campos Family Dental, P.C. | Dentist | 6140 Wurzbach Road, San Antonio, TX 78238 | 2009-11-06 |
| 1063665495 | Benjamino L Granato | Durable Medical Equipment & Medical Supplies | 6415 Bandera, San Antonio, TX 78238 | 2008-10-29 |
| 1891962262 | Gerald L Froemming | Dentist | 6436 Bandera Road, #1, San Antonio, TX 78238 | 2008-05-14 |
| Find all providers in zip 78238 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568904175 | Ashlee Anderjeski | Specialist | 10218 Castello Cyn, San Antonio, TX 78254-4551 | 2016-11-14 |
| 1831641059 | Lone Star Cardiovascular Center Pllc | Specialist | 9130 Wurzbach Rd Ste 104, San Antonio, TX 78240-1070 | 2016-11-04 |
| 1851753396 | Coral Ramirez Camacho | Specialist | 7827 Clos Du Bois, San Antonio, TX 78253-4880 | 2016-03-23 |
| 1174984371 | Crossover Health | Specialist | 3838 Rogers Rd, San Antonio, TX 78251-3662 | 2016-03-15 |
| 1033585948 | Job Adventures | Specialist | 4606 Centerview Ste 200, San Antonio, TX 78228-1205 | 2015-08-14 |
| 1790168417 | San Antonio Head & Neck Surgical Associates | Specialist | 926 Booklyn Ave, San Antonio, TX 78215-1637 | 2015-06-30 |
| 1255738514 | Amy Beth Flores | Specialist | 7134 Washita Way, San Antonio, TX 78256-2339 | 2014-12-01 |
| 1730582263 | Womens Center At Westover Hills | Specialist | 1315 N. Ellison Dr., San Antonio, TX 78251 | 2014-09-29 |
| 1811396799 | Intravascular Access Team | Specialist | 8415 Fredericksburg Rd, Unit 906, San Antonio, TX 78229-3173 | 2014-08-17 |
| 1497164990 | Next Generation Orthopedic & Spine Institute, Pllc | Specialist | 1626 Lockhill Selma Rd, Suite 2, San Antonio, TX 78213-1929 | 2014-08-08 |
| Find all providers in SAN ANTONIO | ||||
| City | SAN ANTONIO |
| Zip Code | 78238 |
Please comment or provide details below to improve the information on PAIN & NEUROMUSCULAR CLINIC OF TEXAS , P.A..
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.