Provider Demographics
NPI:1851581508
Name:SPECTRUM ANESTHESIA & PAIN SERVICES
Entity Type:Organization
Organization Name:SPECTRUM ANESTHESIA & PAIN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:E
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-630-6301
Mailing Address - Street 1:PO BOX 720658
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-0658
Mailing Address - Country:US
Mailing Address - Phone:956-630-6301
Mailing Address - Fax:956-630-6019
Practice Address - Street 1:5017 S MCCOLL RD STE B
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-7884
Practice Address - Country:US
Practice Address - Phone:956-630-6301
Practice Address - Fax:956-630-6019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8420261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00876NMedicare PIN
TXG11785Medicare UPIN