Provider Demographics
NPI:1144881814
Name:TEXAS MERCY HEADACHE AND PAIN PLLC
Entity type:Organization
Organization Name:TEXAS MERCY HEADACHE AND PAIN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-984-0311
Mailing Address - Street 1:4925 N O CONNOR RD STE 105
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-2760
Mailing Address - Country:US
Mailing Address - Phone:469-984-0311
Mailing Address - Fax:
Practice Address - Street 1:4925 N O CONNOR RD STE 105
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-2760
Practice Address - Country:US
Practice Address - Phone:469-984-0311
Practice Address - Fax:214-594-0203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty