Healthcare Provider Details

I. General information

NPI: 1568745263
Provider Name (Legal Business Name): ADVANCED INVASIVE PAIN MANAGEMENT OF HOUSTON, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2011
Last Update Date: 09/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 FM 1960 RD W # 204
HUMBLE TX
77338-4125
US

IV. Provider business mailing address

PO BOX 5807
KINGWOOD TX
77325-5807
US

V. Phone/Fax

Practice location:
  • Phone: 713-943-7246
  • Fax: 713-943-2040
Mailing address:
  • Phone: 713-943-7246
  • Fax: 713-943-2040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberG1453
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberL1737
License Number StateTX

VIII. Authorized Official

Name: DR. JERRY M KEEPERS
Title or Position: PRESIDENT
Credential: MD
Phone: 713-943-7246