Provider Demographics
NPI:1043433782
Name:CENTER FOR PAIN MANAGEMENT PLLC
Entity type:Organization
Organization Name:CENTER FOR PAIN MANAGEMENT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN OF THE BOARD
Authorized Official - Prefix:
Authorized Official - First Name:TAJUL
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHOWDHURY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-631-9041
Mailing Address - Street 1:2637 CORNERSTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-8479
Mailing Address - Country:US
Mailing Address - Phone:956-631-9041
Mailing Address - Fax:956-972-0549
Practice Address - Street 1:2637 CORNERSTONE BLVD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-8479
Practice Address - Country:US
Practice Address - Phone:956-631-9041
Practice Address - Fax:956-972-0549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX085535502Medicaid
TX85Z780OtherBLUE CROSS BLUE SHIELD
TX85Z780OtherBLUE CROSS BLUE SHIELD