Healthcare Provider Details

I. General information

NPI: 1477099851
Provider Name (Legal Business Name): MINIVASIVE PAIN SPECIALISTS,PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2017
Last Update Date: 07/16/2020
Certification Date: 07/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 SPRING STUEBNER RD SUITE 110
SPRING TX
77389-5194
US

IV. Provider business mailing address

3301 SPRING STUEBNER RD SUITE 110
SPRING TX
77389-5194
US

V. Phone/Fax

Practice location:
  • Phone: 346-800-6001
  • Fax: 346-800-6002
Mailing address:
  • Phone: 346-800-6001
  • Fax: 346-800-6002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PHONG QUOC LE
Title or Position: PROVIDER/OWNER
Credential: D.O
Phone: 346-800-6001