Provider Demographics
NPI:1659736973
Name:BACAS INTERVENTIONAL PAIN MANAGEMENT, LLC
Entity Type:Organization
Organization Name:BACAS INTERVENTIONAL PAIN MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:K
Authorized Official - Last Name:BOND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:844-342-2227
Mailing Address - Street 1:1302 WAUGH DR
Mailing Address - Street 2:#533
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77019-3908
Mailing Address - Country:US
Mailing Address - Phone:844-342-2227
Mailing Address - Fax:713-401-9758
Practice Address - Street 1:3838 N SAM HOUSTON PKWY E
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77032-3400
Practice Address - Country:US
Practice Address - Phone:844-342-2227
Practice Address - Fax:713-401-9758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-31
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4253208VP0014X
FLME111629208VP0014X
291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
45D2057171OtherCLIA
TX1927384OtherUNITED HEALTHCARE
TX8FL159OtherBLUE CROSS BLUE SHIELD
TX7339911OtherAETNA
TX6465986OtherCIGNA