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General NPI Number Information
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NPI Number | 1346441565
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Entity Type | Organization
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Legal Business Name | INTERDISCIPLIINARY PAIN MANAGEMENT
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Dates
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Enumeration Date | 05/29/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1608 AVENUE O
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City | HUNTSVILLE
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State | TX
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Zip | 77340-4418
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Country | US
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Telephone | 936-436-1796
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Fax | 936-291-6396
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Provider Business Mailing Address
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Address Line | 1608 AVENUE O
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City | HUNTSVILLE
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State | TX
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Zip | 77340-4418
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Country | US
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Telephone | 936-436-1796
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Fax | 936-291-6396
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DENNIS MOEHR
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Credential |
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Telephone | 936-436-1796
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | H9937
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License Number State | TX
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