MEDICARE: AA TEXAS ANESTHESIA BACK PAIN CENTER MDPA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LP2900X	Pain Medicine (Anesthesiology) Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0058PC	OTHER	TX	BC/BS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639368467
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AA TEXAS ANESTHESIA BACK PAIN CENTER MDPA

Provider Business Mailing Address
First Line	:	PO BOX 271622
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77277-1622
Country	:	US
Telephone Number	:	877-433-4352
Fax Number	:	877-433-4352

Provider Business Practice Location Address
First Line	:	2646 S LOOP W STE 300
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-2678
Country	:	US
Telephone Number	:	713-663-7246
Fax Number	:	877-433-4352

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	AJAY K AGGARWAL
Credential	:
Telephone Number	:	877-433-4352

Provider Enumeration Date	:	10/17/2007
Last Update Date	:	12/04/2008

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