Willowbend Interventional Pain Center, LLC

Primary specialty

Pain Clinic/CenterTaxonomy code 261QP3300X

Legal business name

WILLOWBEND INTERVENTIONAL PAIN CENTER, LLC

Practice address

17051 Dallas Pkwy
Ste 100
Addison, TX 75001-7101

Phone

(469) 916-0521

Fax

(972) 234-0212

NPI assigned

Mar 11, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tracy Walls

Title

Manager

Phone

(972) 234-4740

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1268265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1380672000000",
    "number": "1093038507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 268996",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731268996",
            "telephone_number": "469-916-0521",
            "fax_number": "972-234-0212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17051 DALLAS PKWY",
            "address_2": "STE 100",
            "city": "ADDISON",
            "state": "TX",
            "postal_code": "750017101",
            "telephone_number": "469-916-0521",
            "fax_number": "972-234-0212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOWBEND INTERVENTIONAL PAIN CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-11",
        "last_updated": "2013-10-02",
        "status": "A",
        "authorized_official_last_name": "WALLS",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "972-234-4740"
    },
    "taxonomies": [
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Audra White, NRCMA
• Caroline Wieck, M.S., CCC-SLP
• Holly Wiese
• Charleen Wilder
• Alesha Lizzette Williams, LPC
• Emily Paige Wilson, M.S., CCC-SLP
• Katherine McMillan Wilson, LPC
• Lisa Wilson
• Tina E Wilson, LCSW
• Windhaven Interventional Pain Center, LLC

• Pain Clinic/Center in Addison, TX
• Providers in Addison, TX by specialty
• Pain Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.