Provider Demographics
NPI:1225396401
Name:ACE PAIN MANAGEMENT REHAB & PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:ACE PAIN MANAGEMENT REHAB & PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:SURYA
Authorized Official - Middle Name:P
Authorized Official - Last Name:RAGUTHU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-546-7530
Mailing Address - Street 1:315 JOSE MARTI BLVD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526
Mailing Address - Country:US
Mailing Address - Phone:956-546-7530
Mailing Address - Fax:956-546-7531
Practice Address - Street 1:315 JOSE MARTI BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526
Practice Address - Country:US
Practice Address - Phone:956-546-7530
Practice Address - Fax:956-546-7531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-25
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9857261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0288640Medicaid
TXH24131Medicare PIN
8F0062Medicare PIN