Provider Demographics
NPI:1770034209
Name:PERFORMANCE PAIN AND SPORTS MEDICINE, PLLC
Entity Type:Organization
Organization Name:PERFORMANCE PAIN AND SPORTS MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:FEILER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:346-308-6741
Mailing Address - Street 1:PO BOX 4318
Mailing Address - Street 2:DEPT 725
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4318
Mailing Address - Country:US
Mailing Address - Phone:346-217-1111
Mailing Address - Fax:346-571-2189
Practice Address - Street 1:4126 SOUTHWEST FWY STE 1700
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-7317
Practice Address - Country:US
Practice Address - Phone:346-217-1111
Practice Address - Fax:346-571-2189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-19
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7457332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX509081ZVJDMedicare PIN
TX507787ZVE8Medicare PIN