Provider Demographics
NPI:1740731074
Name:ALLIANCE SPINE AND PAIN MANAGEMENT, PLLC
Entity type:Organization
Organization Name:ALLIANCE SPINE AND PAIN MANAGEMENT, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJESH
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-839-6451
Mailing Address - Street 1:PO BOX 47894
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78265-8894
Mailing Address - Country:US
Mailing Address - Phone:210-920-8945
Mailing Address - Fax:210-944-0919
Practice Address - Street 1:1002 E BLANCO RD STE B
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-1802
Practice Address - Country:US
Practice Address - Phone:210-920-8945
Practice Address - Fax:210-944-0919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-21
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ3290207LP2900X
207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX587948OtherMEDICARE
TX400042401Medicaid