Basic Information
| Provider Information | |||||||||
| NPI: | 1629048582 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MAINLAND ANESTHESIA ASSOCIATES, P.A. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MAINLAND PAIN CONSULTANTS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3945 | ||||||||
| Address2: | DEPT 576 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 772533945 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7135108522 | ||||||||
| FaxNumber: | 9498622868 | ||||||||
| Practice Location | |||||||||
| Address1: | 3750 MEDICAL PARK DRIVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | DICKINSON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2815341133 | ||||||||
| FaxNumber: | 2815342190 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2006 | ||||||||
| LastUpdateDate: | 06/21/2011 | ||||||||
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| AuthorizedOfficialLastName: | PINCHOT | ||||||||
| AuthorizedOfficialFirstName: | HARRISON | ||||||||
| AuthorizedOfficialMiddleName: | KEITH | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2815341133 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | H7207 | TX | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | H7207 | TX | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 208VP0014X | H7207 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00L20G | 01 | TX | BLUE CROSS/BLUE SHIELD | OTHER | 083667801 | 05 | TX | MEDICAID | CC8952 | 01 | TX | RAILROAD MEDICARE | OTHER | 00C30N | 01 | TX | BLUE CROSS/BLUE SHIELD | OTHER | 090123301 | 05 | TX | MEDICAID |