MEDICARE: GALLERIA PAIN PHYSICIANS PLLC

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	:	1922690122
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GALLERIA PAIN PHYSICIANS PLLC

Provider Business Mailing Address
First Line	:	PO BOX 690572
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77269-0572
Country	:	US
Telephone Number	:	281-646-9252
Fax Number	:	281-817-1179

Provider Business Practice Location Address
First Line	:	707 S FRY RD STE 290
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77450-2258
Country	:	US
Telephone Number	:	281-646-9252
Fax Number	:	281-817-1179

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	KEVIN S BARTON
Credential	:	DC
Telephone Number	:	210-885-6752

Provider Enumeration Date	:	02/09/2021
Last Update Date	:	02/09/2021

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