Omni Pain Clinic Inc

Primary specialty

Pain Medicine PhysicianTaxonomy code 208VP0000X

License

P1462 Issued in TX

Legal business name

OMNI PAIN CLINIC INC

Practice address

513 W Jefferson Blvd.
Suite 170
Grand Prairie, TX 75051-1639

Phone

(972) 642-5855

Fax

(972) 642-5853

NPI assigned

Oct 24, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Augusta U. Ikhisemojie, MD

Title

Ceo

Phone

(972) 642-5855

Specialties & licenses 2

Addresses

Other identifiers 1

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

{
    "created_epoch": "1351036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351814400000",
    "number": "1841543097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P O BOX 294822",
            "city": "LEWISVILLE",
            "state": "TX",
            "postal_code": "750294822",
            "telephone_number": "972-642-5855",
            "fax_number": "972-642-5853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "513 W JEFFERSON BLVD.",
            "address_2": "SUITE 170",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750511639",
            "telephone_number": "972-642-5855",
            "fax_number": "972-642-5853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OMNI PAIN CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-24",
        "last_updated": "2012-11-02",
        "status": "A",
        "authorized_official_last_name": "IKHISEMOJIE",
        "authorized_official_first_name": "AUGUSTA",
        "authorized_official_middle_name": "U.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "972-642-5855",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "P1462",
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "TX",
            "license": "P1462",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS LISENCE",
            "identifier": "P1462",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pain Medicine Physician in Grand Prairie, TX
• Providers in Grand Prairie, TX by specialty
• Pain Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2012; 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.