1811090376 NPI number — WOODLANDS PAIN CONSULTANTS,PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811090376 NPI number — WOODLANDS PAIN CONSULTANTS,PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WOODLANDS PAIN CONSULTANTS,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:
Provider Other Organization Name Type Code:
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:
1811090376
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1544 SAWDUST RD STE 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77380-2904
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-194-9102
Provider Business Mailing Address Fax Number:
832-663-9371

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1441 WOODSTEAD CT
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
SPRING
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77380-1410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-319-4910
Provider Business Practice Location Address Fax Number:
832-663-9371
Provider Enumeration Date:
09/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HENRY
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
281-319-4910

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  J4247 , 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)





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