Healthcare Provider Details

I. General information

NPI: 1992097661
Provider Name (Legal Business Name): RGV PAIN MANAGEMENT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2011
Last Update Date: 03/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 VICTORIA LN SUITE 5
HARLINGEN TX
78550-3226
US

IV. Provider business mailing address

512 VICTORIA LN SUITE 5
HARLINGEN TX
78550-3226
US

V. Phone/Fax

Practice location:
  • Phone: 956-421-5660
  • Fax: 956-421-5670
Mailing address:
  • Phone: 956-421-5660
  • Fax: 956-421-5670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberM8177
License Number StateTX

VIII. Authorized Official

Name: ROBERT W MCINTOSH
Title or Position: PRESIDENT & CEO
Credential: DO
Phone: 956-421-5660