Provider Demographics
NPI:1245684596
Name:PASADENA PPM, LLC
Entity type:Organization
Organization Name:PASADENA PPM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOYLES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-944-0189
Mailing Address - Street 1:3350 FAIRVIEW ST.
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-1904
Mailing Address - Country:US
Mailing Address - Phone:713-944-0189
Mailing Address - Fax:713-944-6116
Practice Address - Street 1:3350 FAIRVIEW ST.
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1904
Practice Address - Country:US
Practice Address - Phone:713-944-9830
Practice Address - Fax:713-944-6116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-22
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty