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Organization
PAIN CARE CLINICS, PA
Active
Organization
PAIN CARE CLINICS, PA
Active
Other names
CARE CLINICS, PA
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JON ERIC CHANCELLOR MD (OWNER)
(830) 792-4805
Entity
Organization
Contact information
Practice address
703 HILL COUNTRY DR STE 301, KERRVILLE, TX 78028-6162
(830) 792-4805
(830) 792-4883
Mailing address
703 HILL COUNTRY DR STE 301, KERRVILLE, TX 78028-6162
(830) 792-4805
(830) 792-4883
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0047KP
BC/BS
TX
05
—
0163190502
—
TX
01
—
163190503
MEDICAID, TSTEPS
TX
01
—
DC1911
RR MEDICARE
TX
Enumeration date
05/12/2006
Last updated
01/09/2020
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