Provider Demographics
NPI:1871715649
Name:PAIN AND HEALTH MANAGEMENT CENTER PA
Entity type:Organization
Organization Name:PAIN AND HEALTH MANAGEMENT CENTER PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:HAL
Authorized Official - Last Name:CHARNOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-932-0770
Mailing Address - Street 1:915 GESSNER RD
Mailing Address - Street 2:SUITE 970
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2527
Mailing Address - Country:US
Mailing Address - Phone:713-932-0770
Mailing Address - Fax:713-932-8595
Practice Address - Street 1:915 GESSNER RD.
Practice Address - Street 2:SUITE 970
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024
Practice Address - Country:US
Practice Address - Phone:713-932-0770
Practice Address - Fax:713-932-8595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6111208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX85283201Medicaid
TX00Z397OtherMEDICARE PTAN
TX123129201Medicaid
TX85283201Medicaid