Provider Demographics
NPI:1730263955
Name:SOUTH TEXAS PAIN & HEALTH MANAGEMENT
Entity type:Organization
Organization Name:SOUTH TEXAS PAIN & HEALTH MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WOLE
Authorized Official - Middle Name:EMMANUEL
Authorized Official - Last Name:OLADUTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:281-238-5480
Mailing Address - Street 1:PO BOX 1674
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77487-1674
Mailing Address - Country:US
Mailing Address - Phone:281-238-5480
Mailing Address - Fax:832-595-9796
Practice Address - Street 1:1601 MAIN ST STE 407
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-3244
Practice Address - Country:US
Practice Address - Phone:281-238-5480
Practice Address - Fax:832-595-9796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0170207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Not Answered208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0045EEOtherBCBS OF TEXAS
00U58YMedicare ID - Type Unspecified
TX0045EEOtherBCBS OF TEXAS