Provider Demographics
NPI:1063520716
Name:PAIN MANAGEMENT CENTER OF HOUSTON PA
Entity type:Organization
Organization Name:PAIN MANAGEMENT CENTER OF HOUSTON PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-755-4412
Mailing Address - Street 1:9100 FOREST XING STE A
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-1194
Mailing Address - Country:US
Mailing Address - Phone:936-755-4412
Mailing Address - Fax:713-422-2169
Practice Address - Street 1:9100 FOREST XING STE A
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-1194
Practice Address - Country:US
Practice Address - Phone:936-755-4412
Practice Address - Fax:713-422-2169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX083267701Medicaid
TX00J87AMedicare ID - Type Unspecified