Provider Demographics
NPI:1639370638
Name:WEST TEXAS PAIN INSTITUTE, LLC
Entity Type:Organization
Organization Name:WEST TEXAS PAIN INSTITUTE, LLC
Other - Org Name:WEST TEXAS SURGICENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:MANGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-239-4488
Mailing Address - Street 1:4316 23RD ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1812
Mailing Address - Country:US
Mailing Address - Phone:806-791-4588
Mailing Address - Fax:
Practice Address - Street 1:4316 23RD ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1812
Practice Address - Country:US
Practice Address - Phone:806-791-4588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0800033644261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical