Provider Demographics
NPI:1528795150
Name:LAKE HOUSTON INTERVENTIONAL PAIN PLLC
Entity type:Organization
Organization Name:LAKE HOUSTON INTERVENTIONAL PAIN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL / MD
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHARLESTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-713-5556
Mailing Address - Street 1:7040 FM 1960 RD E
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-2704
Mailing Address - Country:US
Mailing Address - Phone:281-713-5556
Mailing Address - Fax:409-554-0921
Practice Address - Street 1:7040 FM 1960 RD E
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-2704
Practice Address - Country:US
Practice Address - Phone:281-713-5556
Practice Address - Fax:409-554-0921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty