1245590785 NPI number — PLB UNITED, PA

Table of content: (NPI 1245590785)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245590785 NPI number — PLB UNITED, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PLB UNITED, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ADVOCATE PAIN MANAGEMENT CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245590785
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
923 PASADENA FWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77506-1400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-475-8686
Provider Business Mailing Address Fax Number:
713-475-8688

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1315 ST JOSEPH PKWY
Provider Second Line Business Practice Location Address:
STE 1507
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77002-8233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-475-8686
Provider Business Practice Location Address Fax Number:
713-475-8688
Provider Enumeration Date:
05/17/2012

Additional Information

Authorized Official

Authorized Official Last Name:
DORSETT
Authorized Official First Name:
ALLEN
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
OWENR/PHYSICIAN
Authorized Official Telephone Number:
713-475-8686

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208100000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2081P2900X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208VP0000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0014X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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