Provider Demographics
NPI:1518264670
Name:WORKERS PAIN MANAGEMENT CENTER, PLLC
Entity Type:Organization
Organization Name:WORKERS PAIN MANAGEMENT CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:HOLBERTON
Authorized Official - Last Name:SQUARE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-777-3151
Mailing Address - Street 1:PO BOX 961783
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79996-1783
Mailing Address - Country:US
Mailing Address - Phone:915-777-3151
Mailing Address - Fax:915-855-6111
Practice Address - Street 1:11880 VISTA DEL SOL DR STE B
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-6128
Practice Address - Country:US
Practice Address - Phone:915-777-3151
Practice Address - Fax:915-855-6111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-24
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7650207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX290386601Medicaid