Provider Demographics
NPI:1861410433
Name:NEUROLOGY & PAIN CLINIC, P.A.
Entity type:Organization
Organization Name:NEUROLOGY & PAIN CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:QAISER
Authorized Official - Middle Name:J
Authorized Official - Last Name:YUSUF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-428-7246
Mailing Address - Street 1:2306 N ALEXANDER DR
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77520-3455
Mailing Address - Country:US
Mailing Address - Phone:281-428-7246
Mailing Address - Fax:281-422-3625
Practice Address - Street 1:2306 N ALEXANDER DR
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77520-3455
Practice Address - Country:US
Practice Address - Phone:281-428-7246
Practice Address - Fax:281-422-3625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1818261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX08088301Medicaid
TX08088301Medicaid
TX0061BHMedicare ID - Type UnspecifiedMEDICARE NUMBER