# INTEGRATIVE PAIN INSTITUTE PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376097493
- **Authorized official:** SHAWNA BOUDREAUX (VP OPERATIONS)
- **Authorized official phone:** (469) 422-0641

## Contact information

- **Practice address:** 15110 DALLAS PKWY STE 102, DALLAS, TX 75248-4601
- **Practice address phone:** (972) 349-1333
- **Practice address fax:** (972) 792-0290
- **Mailing address:** 15110 DALLAS PKWY STE 102, DALLAS, TX 75248-4601
- **Mailing address phone:** (972) 302-3489

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | Q9070 | TX | — |
| 208D00000X | General Practice Physician | Q9070 | TX | Yes |
| 208VP0014X | Interventional Pain Medicine Physician | Q9070 | TX | — |

## Other

- **Enumeration date:** 08/05/2016
- **Last updated:** 02/07/2019