Provider Demographics
NPI:1669859948
Name:SOUTH TEXAS PAIN & RECOVERY CENTER LLC
Entity Type:Organization
Organization Name:SOUTH TEXAS PAIN & RECOVERY CENTER LLC
Other - Org Name:MEDI-PRO ORTHOPAEDIC & SPINE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-485-7912
Mailing Address - Street 1:7220 LOUIS PASTEUR DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4537
Mailing Address - Country:US
Mailing Address - Phone:210-485-4912
Mailing Address - Fax:210-579-7156
Practice Address - Street 1:7220 LOUIS PASTEUR DR
Practice Address - Street 2:SUITE 130
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4537
Practice Address - Country:US
Practice Address - Phone:210-485-4912
Practice Address - Fax:210-579-7156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMDP6882TX207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty