Healthcare Provider Details

I. General information

NPI: 1710153408
Provider Name (Legal Business Name): ST. MICHAEL'S PAIN AND SPINE CLINICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2008
Last Update Date: 04/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2646 S, LOOP WEST STE 106
HOUSTON TX
77054-1901
US

IV. Provider business mailing address

2646 S. LOOP WEST STE 106
HOUSTON TX
77054-1901
US

V. Phone/Fax

Practice location:
  • Phone: 713-661-0300
  • Fax: 281-822-0480
Mailing address:
  • Phone: 713-661-0300
  • Fax: 281-822-0480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MIGUEL ANGEL PAPPOLLA
Title or Position: OWNER
Credential: MD
Phone: 713-661-0300