1750602652 NPI number — PLB UNITED, PA

Table of content: (NPI 1750602652)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750602652 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:
1750602652
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:
923 PASADENA FREEWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77506-1400
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:
06/15/2010

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 2081P2900X , with the licence number:  L9171 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208VP0014X , with the licence number: L9171 , 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)

  • Identifier: 1104001213 . This is a "GROUP BILLING NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1710920483 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 18036601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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