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
StateLicense IDTaxonomies
TXJ1013207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty