Provider Demographics
NPI:1285669812
Name:ADVANCED INVASIVE PAIN MANAGEMENT OF HOUSTON PA
Entity type:Organization
Organization Name:ADVANCED INVASIVE PAIN MANAGEMENT OF HOUSTON PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:MAY
Authorized Official - Last Name:KEEPERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-943-7246
Mailing Address - Street 1:PO BOX 5807
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77325-5807
Mailing Address - Country:US
Mailing Address - Phone:713-943-7246
Mailing Address - Fax:713-943-0167
Practice Address - Street 1:308 W PARKWOOD AVE
Practice Address - Street 2:STE 106
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-5478
Practice Address - Country:US
Practice Address - Phone:713-943-7246
Practice Address - Fax:713-943-0167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10023613OtherAMERIGROUP STAR PLUS
TX177211301Medicaid
TX26JSOtherBLUE CROSS BLUE SHIELD
TX352434000OtherUS DEPARTMENT OF LABOR
TXCD8579OtherPALMETTO GBA
TX177211301Medicaid
TX00183WMedicare PIN
TX00183WMedicare ID - Type Unspecified