Provider Demographics
NPI:1508368747
Name:INTERVENTIONAL PAIN SPECIALISTS, PLLC
Entity Type:Organization
Organization Name:INTERVENTIONAL PAIN SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:DIETER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-991-2200
Mailing Address - Street 1:PO BOX 5607
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77508-5607
Mailing Address - Country:US
Mailing Address - Phone:281-991-2200
Mailing Address - Fax:281-991-7700
Practice Address - Street 1:7111 MEDICAL CENTER DR STE 100
Practice Address - Street 2:
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591-2667
Practice Address - Country:US
Practice Address - Phone:281-991-2200
Practice Address - Fax:281-991-7700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-04
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty