Provider Demographics
NPI:1922011774
Name:HEADACHE AND MIGRAINE INSTITUTE OF TEXAS, P.A.
Entity Type:Organization
Organization Name:HEADACHE AND MIGRAINE INSTITUTE OF TEXAS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NASHA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HOLT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-402-2920
Mailing Address - Street 1:PO BOX 2613
Mailing Address - Street 2:
Mailing Address - City:UNIVERSAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78148-1613
Mailing Address - Country:US
Mailing Address - Phone:210-402-2920
Mailing Address - Fax:210-403-9827
Practice Address - Street 1:400 N LOOP 1604 E
Practice Address - Street 2:SUITE 345
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1258
Practice Address - Country:US
Practice Address - Phone:210-402-2920
Practice Address - Fax:210-403-9827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4084207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherFEDERAL TAX ID