Provider Demographics
NPI:1578304499
Name:ALAVIE INTERVENTIONAL PAIN MANAGEMENT, PLLC
Entity type:Organization
Organization Name:ALAVIE INTERVENTIONAL PAIN MANAGEMENT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:HORAN
Authorized Official - Last Name:SAMUELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-664-4446
Mailing Address - Street 1:12702 TOEPPERWEIN RD STE 104
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-3266
Mailing Address - Country:US
Mailing Address - Phone:210-664-4446
Mailing Address - Fax:
Practice Address - Street 1:1001 WATER ST STE E-100
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-3761
Practice Address - Country:US
Practice Address - Phone:210-664-4446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty