MEDICARE: ADVANCED INVASIVE PAIN MANAGEMENT OF HOUSTON, PA

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	208100000X	Physical Medicine & Rehabilitation Physician	L1737	TX
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	G1453	TX

General Provider Information

NPI Number	:	1679856371
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED INVASIVE PAIN MANAGEMENT OF HOUSTON, PA

Provider Business Mailing Address
First Line	:	PO BOX 5807
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77325-5807
Country	:	US
Telephone Number	:	713-943-7246
Fax Number	:	713-943-2040

Provider Business Practice Location Address
First Line	:	25440 INTERSTATE 45 N STE 200
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77386-1343
Country	:	US
Telephone Number	:	713-943-7246
Fax Number	:	713-943-2040

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JERRY M KEEPERS
Credential	:	MD
Telephone Number	:	713-943-7246

Provider Enumeration Date	:	09/20/2011
Last Update Date	:	09/20/2011

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