Provider Demographics
NPI:1730629403
Name:PAIN & REHAB SERVICES OF THE SW
Entity type:Organization
Organization Name:PAIN & REHAB SERVICES OF THE SW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:281-837-3757
Mailing Address - Street 1:8251 BEDFORD EULESS RD
Mailing Address - Street 2:
Mailing Address - City:N RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-7200
Mailing Address - Country:US
Mailing Address - Phone:281-837-3757
Mailing Address - Fax:281-837-7501
Practice Address - Street 1:4308 GARTH RD STE C
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3114
Practice Address - Country:US
Practice Address - Phone:281-837-3757
Practice Address - Fax:281-837-7501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR0400X
TX2-5626261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation