Provider Demographics
NPI:1952722670
Name:PAIN MANAGEMENT CONSULTANTS IN COASTAL BEND PLLC
Entity Type:Organization
Organization Name:PAIN MANAGEMENT CONSULTANTS IN COASTAL BEND PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:YELDERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-952-3018
Mailing Address - Street 1:3757 FM 1781
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:TX
Mailing Address - Zip Code:78382-7613
Mailing Address - Country:US
Mailing Address - Phone:214-952-3018
Mailing Address - Fax:
Practice Address - Street 1:1711 W WHEELER AVE
Practice Address - Street 2:
Practice Address - City:ARANSAS PASS
Practice Address - State:TX
Practice Address - Zip Code:78336-4536
Practice Address - Country:US
Practice Address - Phone:214-952-3018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-23
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1973174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty