Provider Demographics
NPI:1437452638
Name:PEARLAND BACK AND NECK CLINIC
Entity Type:Organization
Organization Name:PEARLAND BACK AND NECK CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-347-7246
Mailing Address - Street 1:10950 MEMORIAL HERMANN DR
Mailing Address - Street 2:STE 203
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584
Mailing Address - Country:US
Mailing Address - Phone:281-347-7246
Mailing Address - Fax:281-347-7250
Practice Address - Street 1:10950 MEMORIAL HERMANN DR
Practice Address - Street 2:STE 203
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584
Practice Address - Country:US
Practice Address - Phone:281-347-7246
Practice Address - Fax:281-347-7250
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOUSTON BACK AND NECK CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-09
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1578208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB104569OtherMEDICARE PTAN