Provider Demographics
NPI:1528733581
Name:MAXIMUM PAIN RELIEF SUPPORT CENTER, PLLC
Entity type:Organization
Organization Name:MAXIMUM PAIN RELIEF SUPPORT CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:DERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:OUTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-498-2112
Mailing Address - Street 1:1319 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-5453
Mailing Address - Country:US
Mailing Address - Phone:713-498-2112
Mailing Address - Fax:
Practice Address - Street 1:2802 GARTH RD STE 109
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3924
Practice Address - Country:US
Practice Address - Phone:281-766-8660
Practice Address - Fax:281-766-8660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-11
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain