Provider Demographics
NPI:1619386729
Name:COLVIN PAIN MANAGEMENT PLLC
Entity Type:Organization
Organization Name:COLVIN PAIN MANAGEMENT PLLC
Other - Org Name:INTERVENTIONAL PAIN MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:N
Authorized Official - Last Name:COLVIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-797-4596
Mailing Address - Street 1:4642 N LOOP 289 STE 209
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-2425
Mailing Address - Country:US
Mailing Address - Phone:806-797-4596
Mailing Address - Fax:855-529-0586
Practice Address - Street 1:4642 N LOOP 289 STE 209
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-2425
Practice Address - Country:US
Practice Address - Phone:806-797-4596
Practice Address - Fax:855-529-0586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-04
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2313174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137839014Medicaid
TXE45813Medicare UPIN