Provider Demographics
NPI:1043644339
Name:PAIN MANAGEMENT CLINIC OF CORPUS CHRISTI, P.A.
Entity Type:Organization
Organization Name:PAIN MANAGEMENT CLINIC OF CORPUS CHRISTI, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUDSON
Authorized Official - Middle Name:J
Authorized Official - Last Name:SOMERVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-806-2001
Mailing Address - Street 1:4646 CORONA DR STE 256
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4307
Mailing Address - Country:US
Mailing Address - Phone:361-806-2001
Mailing Address - Fax:361-852-0626
Practice Address - Street 1:4646 CORONA DR STE 256
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4307
Practice Address - Country:US
Practice Address - Phone:361-806-2001
Practice Address - Fax:361-852-0626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty