Provider Demographics
NPI:1730440785
Name:INTERVENTIONAL PAIN SPECIALISTS, PLLC
Entity type:Organization
Organization Name:INTERVENTIONAL PAIN SPECIALISTS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MONROE
Authorized Official - Last Name:DIETER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-524-5355
Mailing Address - Street 1:16840 BUCCANEER LN STE 261
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-2570
Mailing Address - Country:US
Mailing Address - Phone:281-991-2200
Mailing Address - Fax:281-991-7700
Practice Address - Street 1:6243 FAIRMONT PKWY STE 200
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-4047
Practice Address - Country:US
Practice Address - Phone:281-991-2200
Practice Address - Fax:281-991-7700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-06
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty