Provider Demographics
NPI:1760952022
Name:S E TEXAS PAIN MANAGEMENT PLLC
Entity Type:Organization
Organization Name:S E TEXAS PAIN MANAGEMENT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SASSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:EHDAIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-236-2096
Mailing Address - Street 1:755 N 11TH ST STE P2280
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1525
Mailing Address - Country:US
Mailing Address - Phone:409-236-2096
Mailing Address - Fax:409-236-1612
Practice Address - Street 1:755 N 11TH ST STE P2280
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1525
Practice Address - Country:US
Practice Address - Phone:409-835-0348
Practice Address - Fax:409-892-2760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-29
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty