1801267661 NPI number — INNOVATIVE PAIN AND SPINE INSTITUTE

Table of content: (NPI 1801267661)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801267661 NPI number — INNOVATIVE PAIN AND SPINE INSTITUTE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INNOVATIVE PAIN AND SPINE INSTITUTE
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:
TEXAS PAIN AND WELLNESS CENTER PLLC
Provider Other Organization Name Type Code:
4
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:
1801267661
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9654 KATY FWY STE C200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77055-6341
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-714-7834
Provider Business Mailing Address Fax Number:
888-202-1057

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
114 STEPHANIE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALESTINE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75803-8504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-382-2150
Provider Business Practice Location Address Fax Number:
817-288-0549
Provider Enumeration Date:
10/19/2015

Additional Information

Authorized Official

Authorized Official Last Name:
AMOS
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
Authorized Official Title or Position:
SOLE PROPRIETOR
Authorized Official Telephone Number:
214-293-9067

Provider Taxonomy Codes

  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2081P2900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2081S0010X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208VP0014X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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