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General NPI Number Information
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NPI Number | 1760605273
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Entity Type | Organization
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Legal Business Name | OUTPATIENT CENTER FOR INTERVENTIONAL PAIN MANAGEMENT, P.A.
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2637 CORNERSTONE BLVD
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City | EDINBURG
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State | TX
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Zip | 78539-8479
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Country | US
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Telephone | 956-631-9041
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Fax | 956-972-0549
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Provider Business Mailing Address
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Address Line | 2637 CORNERSTONE BLVD
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City | EDINBURG
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State | TX
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Zip | 78539-8479
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Country | US
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Telephone | 956-631-9041
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Fax | 956-972-0549
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Authorized Official
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Title or Position | C.E.O.
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Name | REVI SANKER
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Credential |
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Telephone | 956-631-9041
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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 |
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License Number State |
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