Provider Demographics
NPI: | 1952681025 |
---|---|
Name: | PAIN CONSULTANTS OF TEXAS PA |
Entity Type: | Organization |
Organization Name: | PAIN CONSULTANTS OF TEXAS PA |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | MD |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ELIEL |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | NTAKIRUTIMANA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 956-717-4074 |
Mailing Address - Street 1: | 6801 MPHERSON RD STE#334 |
Mailing Address - Street 2: | |
Mailing Address - City: | LAREDO |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 78041 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 956-717-4074 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 6801 MCPHERSON RD |
Practice Address - Street 2: | STE 334 |
Practice Address - City: | LAREDO |
Practice Address - State: | TX |
Practice Address - Zip Code: | 78041-6402 |
Practice Address - Country: | US |
Practice Address - Phone: | 956-717-4074 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2011-08-22 |
Last Update Date: | 2011-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | J1013 | 207LP2900X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207LP2900X | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | Group - Multi-Specialty |