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General NPI Number Information
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NPI Number | 1083193031
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Entity Type | Organization
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Legal Business Name | BACAS INTERVENTIONAL PAIN MANAGEMENT, LLC
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Dates
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Enumeration Date | 08/10/2018
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Last Update Date | 08/10/2018
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Provider Practice Location Address
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Address Line | 1430 HIGHWAY 4 E
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City | HOLLY SPRINGS
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State | MS
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Zip | 38635-2140
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Country | US
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Telephone | 844-342-2227
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Fax |
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Provider Business Mailing Address
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Address Line | 1302 WAUGH DR # 533
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City | HOUSTON
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State | TX
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Zip | 77019-3908
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | NELSON K BOND
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Credential | MD
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Telephone | 844-342-2227
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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