Provider Demographics
NPI:1043313315
Name:SOUTHEAST TEXAS INSTITUTE OF PAIN MANAGEMENTP.A
Entity Type:Organization
Organization Name:SOUTHEAST TEXAS INSTITUTE OF PAIN MANAGEMENTP.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GHYASUDDIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SYED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-422-5500
Mailing Address - Street 1:5714 COMAL PARK CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77059
Mailing Address - Country:US
Mailing Address - Phone:713-240-3685
Mailing Address - Fax:281-422-5560
Practice Address - Street 1:2802 GARTH RD STE 109
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3924
Practice Address - Country:US
Practice Address - Phone:281-422-5500
Practice Address - Fax:281-422-5560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160479501Medicaid
TX1043313315Medicaid
TX0087KBOtherBCBS PROVIDER NUMBER