1831699933 NPI number — INTEGRATED HEALTH AND PAIN MANAGEMENT PLLC

Table of content: (NPI 1831699933)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831699933 NPI number — INTEGRATED HEALTH AND PAIN MANAGEMENT PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTEGRATED HEALTH AND PAIN MANAGEMENT PLLC
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:
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Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831699933
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 957
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRIENDSWOOD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77549-0957
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-494-6054
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1120 NASA PKWY STE 220Q
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77058-3342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-494-6054
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/15/2018

Additional Information

Authorized Official

Authorized Official Last Name:
WALKER
Authorized Official First Name:
SIERRA
Authorized Official Middle Name:
N.
Authorized Official Title or Position:
BILLER
Authorized Official Telephone Number:
469-494-6054

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1144517467 . This is a "NPESS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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