Provider Demographics
NPI:1942395710
Name:PAIN CONSULT SERVICES OF TEXAS PA
Entity Type:Organization
Organization Name:PAIN CONSULT SERVICES OF TEXAS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GBADEBO
Authorized Official - Middle Name:J
Authorized Official - Last Name:ADEBAYO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-533-5335
Mailing Address - Street 1:PO BOX 20508
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77225-0508
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6411 FANNIN ST
Practice Address - Street 2:3RD FLOOR ROBERTSON PAVILION
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1501
Practice Address - Country:US
Practice Address - Phone:713-704-2732
Practice Address - Fax:713-704-5711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1330207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00X478Medicare PIN