Provider Demographics
NPI:1477099851
Name:MINIVASIVE PAIN SPECIALISTS,PLLC
Entity Type:Organization
Organization Name:MINIVASIVE PAIN SPECIALISTS,PLLC
Other - Org Name:MINIVASIVE PAIN & ORTHOPEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHONG
Authorized Official - Middle Name:QUOC
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:346-800-6001
Mailing Address - Street 1:3301 SPRING STUEBNER RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77389-5194
Mailing Address - Country:US
Mailing Address - Phone:346-800-6001
Mailing Address - Fax:346-800-6002
Practice Address - Street 1:3301 SPRING STUEBNER RD
Practice Address - Street 2:SUITE 110
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77389-5194
Practice Address - Country:US
Practice Address - Phone:346-800-6001
Practice Address - Fax:346-800-6002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-10
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle SurgeryGroup - Single Specialty