Provider Demographics
NPI:1982418745
Name:PRESTIGE MEDICAL PAIN CLINIC LLC
Entity type:Organization
Organization Name:PRESTIGE MEDICAL PAIN CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:HATCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-656-3460
Mailing Address - Street 1:3310 EDLOE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-6502
Mailing Address - Country:US
Mailing Address - Phone:713-396-7066
Mailing Address - Fax:
Practice Address - Street 1:7927 CYPRESS CREEK PKWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-5707
Practice Address - Country:US
Practice Address - Phone:713-396-7066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain