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General NPI Number Information
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NPI Number | 1164642195
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Entity Type | Organization
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Legal Business Name | PAIN CONTAINMENT ASSOCIATE PA
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 11/13/2007
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Provider Practice Location Address
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Address Line | 1406 S BRYAN RD
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City | MISSION
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State | TX
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Zip | 78572-6674
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Country | US
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Telephone | 956-583-4880
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Fax | 956-583-5280
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Provider Business Mailing Address
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Address Line | PO BOX 1469
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City | MISSION
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State | TX
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Zip | 78573-0025
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Country | US
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Telephone | 956-583-4880
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Fax | 956-583-5280
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SANNICHIE A. QUAICOE
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Credential | M.D.
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Telephone | 956-583-4880
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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 | K1904
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License Number State | TX
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