Provider Demographics
NPI:1477839603
Name:WOODLANDS PAIN IP CENTERS MD PA
Entity Type:Organization
Organization Name:WOODLANDS PAIN IP CENTERS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIVISION MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWBURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-462-1285
Mailing Address - Street 1:5318 WESLAYAN ST STE 183
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-1048
Mailing Address - Country:US
Mailing Address - Phone:888-462-9142
Mailing Address - Fax:
Practice Address - Street 1:2310 FM 1960 RD W
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77068-3727
Practice Address - Country:US
Practice Address - Phone:888-462-9142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty