MEDICARE: PRESTIGE HEALTHCARE ASSOCIATES

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	207LP2900X	Pain Medicine (Anesthesiology) Physician

General Provider Information

NPI Number	:	1871114967
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESTIGE HEALTHCARE ASSOCIATES

Provider Business Mailing Address
First Line	:	PO BOX 218486
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77218-8486
Country	:	US
Telephone Number	:	713-545-9191
Fax Number	:

Provider Business Practice Location Address
First Line	:	1535 WEST LOOP S STE 300
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-0003
Country	:	US
Telephone Number	:	832-404-2018
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	KRAIG KILLOUGH
Credential	:
Telephone Number	:	832-404-2018

Provider Enumeration Date	:	04/30/2020
Last Update Date	:	03/06/2026

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