Provider Demographics
NPI:1720311657
Name:59 PAIN & REHABILITATION CENTER
Entity Type:Organization
Organization Name:59 PAIN & REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THAO
Authorized Official - Middle Name:T
Authorized Official - Last Name:HUYNH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:713-484-6262
Mailing Address - Street 1:7443 SOUTHWEST FWY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1901
Mailing Address - Country:US
Mailing Address - Phone:713-484-6262
Mailing Address - Fax:713-484-6363
Practice Address - Street 1:7443 SOUTHWEST FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1901
Practice Address - Country:US
Practice Address - Phone:713-484-6262
Practice Address - Fax:713-484-6363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC8450261Q00000X
TXDC8151261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1275757825OtherINDIVIDUAL NIP NUMBER
TX1467575415OtherINDIVIDUAL NIP NUMBER