Provider Demographics
NPI:1710153408
Name:ST. MICHAEL'S PAIN AND SPINE CLINICS PLLC
Entity Type:Organization
Organization Name:ST. MICHAEL'S PAIN AND SPINE CLINICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:ANGEL
Authorized Official - Last Name:PAPPOLLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-661-0300
Mailing Address - Street 1:2646 S. LOOP WEST STE 106
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-1901
Mailing Address - Country:US
Mailing Address - Phone:713-661-0300
Mailing Address - Fax:281-822-0480
Practice Address - Street 1:2646 S, LOOP WEST STE 106
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-1901
Practice Address - Country:US
Practice Address - Phone:713-661-0300
Practice Address - Fax:281-822-0480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Z680Medicare PIN