Provider Demographics
NPI:1073282216
Name:STOCKMAN PAIN SERVICES PLLC
Entity Type:Organization
Organization Name:STOCKMAN PAIN SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:STOCKMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:CRNA
Authorized Official - Phone:936-254-4703
Mailing Address - Street 1:3610 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-2539
Mailing Address - Country:US
Mailing Address - Phone:936-254-4703
Mailing Address - Fax:
Practice Address - Street 1:3610 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-2539
Practice Address - Country:US
Practice Address - Phone:936-560-9599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-10
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain