Provider Demographics
NPI:1427217249
Name:CENTER FOR PAIN MANGEMENT
Entity Type:Organization
Organization Name:CENTER FOR PAIN MANGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDE
Authorized Official - Middle Name:MICHEL
Authorized Official - Last Name:OLIVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-791-3377
Mailing Address - Street 1:PO BOX 64123
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79464-4123
Mailing Address - Country:US
Mailing Address - Phone:806-791-3377
Mailing Address - Fax:806-791-3378
Practice Address - Street 1:4316 23RD ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1812
Practice Address - Country:US
Practice Address - Phone:806-791-3377
Practice Address - Fax:806-791-3378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8299261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0897951Medicaid
F65401Medicare UPIN
TX0897951Medicaid