Provider Demographics
NPI:1205857802
Name:PREMIER PAIN MANAGEMENT CONSULTANTS, PA
Entity Type:Organization
Organization Name:PREMIER PAIN MANAGEMENT CONSULTANTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PRAMODH
Authorized Official - Middle Name:K
Authorized Official - Last Name:WADERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:281-265-0774
Mailing Address - Street 1:PO BOX 16404
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77496-6404
Mailing Address - Country:US
Mailing Address - Phone:281-265-0774
Mailing Address - Fax:281-265-0774
Practice Address - Street 1:305 SANDY CORNER RD
Practice Address - Street 2:SUITE # 220
Practice Address - City:EL CAMPO
Practice Address - State:TX
Practice Address - Zip Code:77437-9535
Practice Address - Country:US
Practice Address - Phone:281-265-0774
Practice Address - Fax:281-265-0774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1575207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176808701Medicaid
TX176808702Medicaid
TX00488ZMedicare PIN
TX176808701Medicaid