=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902396161
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GALLERIA PAIN PHYSICIANS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2018
-----------------------------------------------------
Last Update Date | 02/09/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6700 WEST LOOP S STE 225
-----------------------------------------------------
City | BELLAIRE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77401-4104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-480-4740
-----------------------------------------------------
Fax | 281-205-3502
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 690572
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77269-0572
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-480-4740
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. KEVIN BARTON
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 210-885-6752
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208VP0000X
-----------------------------------------------------
Taxonomy Name | Pain Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------