Provider Demographics
NPI:1548757545
Name:QUANTUM PAIN AND ORTHOPEDIC, PLLC
Entity Type:Organization
Organization Name:QUANTUM PAIN AND ORTHOPEDIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:K
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-817-6010
Mailing Address - Street 1:8626 TESORO DR STE 112
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-6217
Mailing Address - Country:US
Mailing Address - Phone:210-817-6010
Mailing Address - Fax:210-817-6011
Practice Address - Street 1:8626 TESORO DR STE 112
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-6217
Practice Address - Country:US
Practice Address - Phone:210-817-6010
Practice Address - Fax:210-817-6011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-16
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR4868207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1336403864OtherALL OTHER INSURANCE