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General NPI Number Information
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NPI Number | 1588165344
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Entity Type | Organization
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Legal Business Name | REVOLUTION PAIN MANAGEMENT, PLLC
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Dates
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Enumeration Date | 02/26/2018
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Last Update Date | 01/03/2019
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Provider Practice Location Address
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Address Line | 1485 FM 1960 BYPASS RD E STE 360
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City | HUMBLE
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State | TX
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Zip | 77338-3964
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Country | US
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Telephone | 281-783-6856
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Fax |
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Provider Business Mailing Address
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Address Line | 50 BRIAR HOLLOW LN STE 300E
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City | HOUSTON
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State | TX
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Zip | 77027-9366
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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 | CREDENTIALING
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Name | KARINA GYER
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Credential |
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Telephone | 832-884-8980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | P5268
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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