Healthcare Provider Details

I. General information

NPI: 1770029167
Provider Name (Legal Business Name): DISC MANAGEMENT GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

10507 E WILDWIND CIR
SPRING TX
77380-4043
US

IV. Provider business mailing address

10507 E WILDWIND CIR
SPRING TX
77380-4043
US

V. Phone/Fax

Practice location:
  • Phone: 281-543-0012
  • Fax: 281-605-4566
Mailing address:
  • Phone: 281-543-0012
  • Fax: 281-605-4566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberK8150
License Number StateTX

VIII. Authorized Official

Name: MARK JASON FILLEY
Title or Position: MANAGER
Credential: M.D.
Phone: 281-543-0012