Provider Demographics
NPI:1760605273
Name:OUTPATIENT CENTER FOR INTERVENTIONAL PAIN MANAGEMENT, P.A.
Entity Type:Organization
Organization Name:OUTPATIENT CENTER FOR INTERVENTIONAL PAIN MANAGEMENT, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:REVI
Authorized Official - Middle Name:
Authorized Official - Last Name:SANKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-631-9041
Mailing Address - Street 1:2637 CORNERSTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-8479
Mailing Address - Country:US
Mailing Address - Phone:956-631-9041
Mailing Address - Fax:956-972-0549
Practice Address - Street 1:2637 CORNERSTONE BLVD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-8479
Practice Address - Country:US
Practice Address - Phone:956-631-9041
Practice Address - Fax:956-972-0549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherTAX IDENTIFICATION NUMBER