MEDICARE: BACAS INTERVENTIONAL PAIN MANAGEMENT, LLC

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	291U00000X	Clinical Medical Laboratory
2	208VP0014X	Interventional Pain Medicine Physician	ME111629	FL
3	208VP0014X	Interventional Pain Medicine Physician	L4253	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1927384	OTHER	TX	UNITED HEALTHCARE
2	8FL159	OTHER	TX	BLUE CROSS BLUE SHIELD
3	6465986	OTHER	TX	CIGNA
4	45D2057171	OTHER		CLIA
5	7339911	OTHER	TX	AETNA

General Provider Information

NPI Number	:	1659736973
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BACAS INTERVENTIONAL PAIN MANAGEMENT, LLC

Provider Business Mailing Address
First Line	:	3838 N SAM HOUSTON PKWY E STE 325
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77032-3400
Country	:	US
Telephone Number	:	844-342-2227
Fax Number	:	713-401-9758

Provider Business Practice Location Address
First Line	:	3838 N SAM HOUSTON PKWY E
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77032-3400
Country	:	US
Telephone Number	:	844-342-2227
Fax Number	:	713-401-9758

Authorized Official
Title or Position	:	MD
Name	:	NELSON K BOND
Credential	:	MD
Telephone Number	:	844-342-2227

Provider Enumeration Date	:	12/31/2015
Last Update Date	:	04/30/2024

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