Provider Demographics
NPI:1033593512
Name:PAIN MANAGEMENT SUPPLIES LLC
Entity Type:Organization
Organization Name:PAIN MANAGEMENT SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-644-0061
Mailing Address - Street 1:24044 CINCO VILLAGE CENTER BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-8433
Mailing Address - Country:US
Mailing Address - Phone:281-644-0061
Mailing Address - Fax:888-330-7541
Practice Address - Street 1:24044 CINCO VILLAGE CENTER BLVD STE 100
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-8433
Practice Address - Country:US
Practice Address - Phone:281-644-0061
Practice Address - Fax:888-330-7541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1001555332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies