Organization
OMNI SPINE PAIN MANAGEMENT, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WHITNEY RAE HUGHES (BILLING DEPARTMENT)
(972) 645-1260
Entity
Organization
Contact information
Practice address
947 SCOTLAND DR STE 107, DESOTO, TX 75115-2095
(214) 705-1200
(214) 705-1201
Mailing address
8380 WARREN PKWY STE 100, FRISCO, TX 75034-4199
(214) 705-1200
(214) 705-1201
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
N1784
STATE LICENSE NUMBER
TX
Enumeration date
11/17/2020
Last updated
12/06/2021
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