Provider Demographics
NPI:1508060740
Name:SHANTI PAIN & WELLNESS CLINIC
Entity Type:Organization
Organization Name:SHANTI PAIN & WELLNESS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IHSAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:SHANTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-339-1566
Mailing Address - Street 1:5611 BELLAIRE BLVD # 376
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-5617
Mailing Address - Country:US
Mailing Address - Phone:713-339-1566
Mailing Address - Fax:713-465-5965
Practice Address - Street 1:5611 BELLAIRE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-5617
Practice Address - Country:US
Practice Address - Phone:713-339-1566
Practice Address - Fax:713-465-5965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X
TXK4562208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00765RMedicare ID - Type UnspecifiedGROUP ID