Provider Demographics
NPI:1164642195
Name:PAIN CONTAINMENT ASSOCIATE PA
Entity Type:Organization
Organization Name:PAIN CONTAINMENT ASSOCIATE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANNICHIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:QUAICOE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-583-4880
Mailing Address - Street 1:PO BOX 1469
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78573-0025
Mailing Address - Country:US
Mailing Address - Phone:956-583-4880
Mailing Address - Fax:956-583-5280
Practice Address - Street 1:1406 S BRYAN RD
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6674
Practice Address - Country:US
Practice Address - Phone:956-583-4880
Practice Address - Fax:956-583-5280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1904208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0018DROtherBLUE CROSS & BLUE SHIELD
TX1133456Medicaid
TX0018DROtherBLUE CROSS & BLUE SHIELD
TX00191JMedicare PIN