Provider Demographics
NPI:1376852855
Name:PAIN MANAGEMENT PROFESSIONALS OF BAYTOWN PLLC
Entity Type:Organization
Organization Name:PAIN MANAGEMENT PROFESSIONALS OF BAYTOWN PLLC
Other - Org Name:ADVANCED PAIN MANAGEMENT SPECIALISTS OF BAYTOWN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DOCTOR/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:OKEZIE
Authorized Official - Middle Name:N
Authorized Official - Last Name:OKEZIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-934-1166
Mailing Address - Street 1:720 1/2 ROLLINGBROOK ST
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-4059
Mailing Address - Country:US
Mailing Address - Phone:281-420-9355
Mailing Address - Fax:281-420-9332
Practice Address - Street 1:720 1/2 ROLLINGBROOK ST
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-4059
Practice Address - Country:US
Practice Address - Phone:281-420-9355
Practice Address - Fax:281-420-9332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-30
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPMC00073261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXL5859OtherMEDICAL LICENSE
TXPMC00073OtherTEXAS MEDICAL BOARD CERTIFICATE NUMBER