MEDICARE: INNOVATIVE PAIN CONSULTANTS LLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP3300X	Pain Clinic/Center

General Provider Information

NPI Number	:	1295109213
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNOVATIVE PAIN CONSULTANTS LLP

Provider Business Mailing Address
First Line	:	11524 SPACE CENTER BLVD
Second Line	:	SUITE 104
City	:	HOUSTON
State	:	TX
Zip	:	77059-3603
Country	:	US
Telephone Number	:	281-487-0890
Fax Number	:	888-507-8586

Provider Business Practice Location Address
First Line	:	11524 SPACE CENTER BLVD
Second Line	:	SUITE 104
City	:	HOUSTON
State	:	TX
Zip	:	77059-3603
Country	:	US
Telephone Number	:	281-487-0890
Fax Number	:	888-507-8586

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DR. JIM CAIN
Credential	:	M.D.
Telephone Number	:	281-487-0890

Provider Enumeration Date	:	11/16/2015
Last Update Date	:	11/16/2015

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