Basic Information
| Provider Information | |||||||||
| NPI: | 1376852855 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PAIN MANAGEMENT PROFESSIONALS OF BAYTOWN PLLC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | ADVANCED PAIN MANAGEMENT SPECIALISTS OF BAYTOWN | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 720 1/2 ROLLINGBROOK ST | ||||||||
| Address2: | |||||||||
| City: | BAYTOWN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775214059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2814209355 | ||||||||
| FaxNumber: | 2814209332 | ||||||||
| Practice Location | |||||||||
| Address1: | 720 1/2 ROLLINGBROOK ST | ||||||||
| Address2: | |||||||||
| City: | BAYTOWN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775214059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2814209355 | ||||||||
| FaxNumber: | 2814209332 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2010 | ||||||||
| LastUpdateDate: | 06/06/2012 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | OKEZIE | ||||||||
| AuthorizedOfficialFirstName: | OKEZIE | ||||||||
| AuthorizedOfficialMiddleName: | N. | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DOCTOR/MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8329341166 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | PMC00073 | TX | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | L5859 | 01 | TX | MEDICAL LICENSE | OTHER | PMC00073 | 01 | TX | TEXAS MEDICAL BOARD CERTIFICATE NUMBER | OTHER |