Basic Information
| Provider Information | |||||||||
| NPI: | 1780023507 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTERVENTIONAL & PAIN MANAGEMENT CENTER, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2686 W ALTON GLOOR BLVD STE 5 | ||||||||
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| City: | BROWNSVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785204054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9563505444 | ||||||||
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| Practice Location | |||||||||
| Address1: | 14 EDGEWATER PL | ||||||||
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| City: | BROWNSVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785211420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9565810303 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2013 | ||||||||
| LastUpdateDate: | 06/14/2013 | ||||||||
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| AuthorizedOfficialLastName: | CHUGHATI | ||||||||
| AuthorizedOfficialFirstName: | SALEEM | ||||||||
| AuthorizedOfficialMiddleName: | ZIA | ||||||||
| AuthorizedOfficialTitleorPosition: | C.E.O. | ||||||||
| AuthorizedOfficialTelephone: | 9564662175 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0000X | L7334 | TX | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | 208VP0014X | L7334 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
No ID Information.