Provider Demographics
NPI:1265918569
Name:ALAVIE INTERVENTIONAL PAIN MANAGEMENT, PLLC
Entity type:Organization
Organization Name:ALAVIE INTERVENTIONAL PAIN MANAGEMENT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:SAMUELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-664-4446
Mailing Address - Street 1:12702 TOEPPERWEIN RD STE 104
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-3266
Mailing Address - Country:US
Mailing Address - Phone:210-664-4446
Mailing Address - Fax:210-664-4447
Practice Address - Street 1:12702 TOEPPERWEIN RD STE 104
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3266
Practice Address - Country:US
Practice Address - Phone:210-644-4446
Practice Address - Fax:210-664-4447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-19
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty