Provider Demographics
NPI:1568745263
Name:ADVANCED INVASIVE PAIN MANAGEMENT OF HOUSTON, PA
Entity Type:Organization
Organization Name:ADVANCED INVASIVE PAIN MANAGEMENT OF HOUSTON, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:KEEPERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-943-7246
Mailing Address - Street 1:PO BOX 5807
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77325-5807
Mailing Address - Country:US
Mailing Address - Phone:713-943-7246
Mailing Address - Fax:713-943-2040
Practice Address - Street 1:8901 FM 1960 RD W # 204
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4125
Practice Address - Country:US
Practice Address - Phone:713-943-7246
Practice Address - Fax:713-943-2040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1453207LP2900X
TXL17372081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00183WMedicare PIN