Provider Demographics
NPI:1407577687
Name:CORPUS PAIN AND HEALTH PLLC
Entity Type:Organization
Organization Name:CORPUS PAIN AND HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:KIMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-897-7494
Mailing Address - Street 1:4929 REMINGTON FALLS DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-2296
Mailing Address - Country:US
Mailing Address - Phone:817-897-7494
Mailing Address - Fax:
Practice Address - Street 1:4639 CORONA DR STE 45
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-5423
Practice Address - Country:US
Practice Address - Phone:361-226-4600
Practice Address - Fax:361-266-4603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty