Provider Demographics
NPI:1265629265
Name:HOUSTON TEXAS PAIN MANAGEMENT
Entity Type:Organization
Organization Name:HOUSTON TEXAS PAIN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCRAE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-357-1370
Mailing Address - Street 1:PO BOX 25408
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77265-5408
Mailing Address - Country:US
Mailing Address - Phone:281-357-1370
Mailing Address - Fax:281-516-7693
Practice Address - Street 1:845 FM 1960 RD W
Practice Address - Street 2:SUITE 106
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-3942
Practice Address - Country:US
Practice Address - Phone:281-357-1370
Practice Address - Fax:281-516-7693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7865208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
8C1318Medicare PIN
E95887Medicare UPIN