Provider Demographics
NPI:1639368467
Name:AA TEXAS ANESTHESIA BACK PAIN CENTER MDPA
Entity Type:Organization
Organization Name:AA TEXAS ANESTHESIA BACK PAIN CENTER MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:AJAY
Authorized Official - Middle Name:K
Authorized Official - Last Name:AGGARWAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-433-4352
Mailing Address - Street 1:PO BOX 271622
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77277-1622
Mailing Address - Country:US
Mailing Address - Phone:877-433-4352
Mailing Address - Fax:877-433-4352
Practice Address - Street 1:2646 S LOOP W STE 300
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2678
Practice Address - Country:US
Practice Address - Phone:713-663-7246
Practice Address - Fax:877-433-4352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0058PCOtherBC/BS
TX131822204Medicaid