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General NPI Number Information
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NPI Number | 1285669812
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Entity Type | Organization
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Legal Business Name | ADVANCED INVASIVE PAIN MANAGEMENT OF HOUSTON PA
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 04/01/2014
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Provider Practice Location Address
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Address Line | 308 W PARKWOOD AVE STE 106
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City | FRIENDSWOOD
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State | TX
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Zip | 77546-5478
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Country | US
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Telephone | 713-943-7246
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Fax | 713-943-0167
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Provider Business Mailing Address
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Address Line | PO BOX 5807
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City | KINGWOOD
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State | TX
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Zip | 77325-5807
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Country | US
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Telephone | 713-943-7246
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Fax | 713-943-0167
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JERRY MAY KEEPERS
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Credential | M.D.
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Telephone | 713-943-7246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number |
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License Number State |
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