Provider Demographics
NPI:1992934590
Name:HOUSTON SPINAL PAIN CENTER
Entity type:Organization
Organization Name:HOUSTON SPINAL PAIN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MONROE
Authorized Official - Suffix:
Authorized Official - Credentials:ANP-BC
Authorized Official - Phone:713-751-0700
Mailing Address - Street 1:2202 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-8814
Mailing Address - Country:US
Mailing Address - Phone:713-751-0700
Mailing Address - Fax:713-751-0701
Practice Address - Street 1:2202 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-8814
Practice Address - Country:US
Practice Address - Phone:713-751-0700
Practice Address - Fax:713-751-0701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-06
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX613756Medicare UPIN