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General NPI Number Information
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NPI Number | 1639370638
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Entity Type | Organization
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Legal Business Name | WEST TEXAS PAIN INSTITUTE, LLC
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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 | 4316 23RD ST
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City | LUBBOCK
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State | TX
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Zip | 79410-1812
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Country | US
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Telephone | 806-791-4588
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Fax |
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Provider Business Mailing Address
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Address Line | 4316 23RD ST
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City | LUBBOCK
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State | TX
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Zip | 79410-1812
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Country | US
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Telephone | 806-791-4588
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Fax |
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Authorized Official
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Title or Position | MANGER
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Name | MICHAEL OLIVA
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Credential |
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Telephone | 806-239-4488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 0800033644
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License Number State | TX
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