1871715649 NPI number — PAIN AND HEALTH MANAGEMENT CENTER PA

Table of content: (NPI 1871715649)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871715649 NPI number — PAIN AND HEALTH MANAGEMENT CENTER PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAIN AND HEALTH MANAGEMENT CENTER 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:
PAIN AND HEALTH 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:
1871715649
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
915 GESSNER RD
Provider Second Line Business Mailing Address:
SUITE 970
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77024-2527
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-932-0770
Provider Business Mailing Address Fax Number:
713-932-8595

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
915 GESSNER RD.
Provider Second Line Business Practice Location Address:
SUITE 970
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-932-0770
Provider Business Practice Location Address Fax Number:
713-932-8595
Provider Enumeration Date:
05/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CHARNOV
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
HAL
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
713-932-0770

Provider Taxonomy Codes

  • Taxonomy code: 208VP0014X , with the licence number:  H6111 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 85283201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00Z397 . This is a "MEDICARE PTAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 123129201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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