Organization
VIKING PAIN MANAGEMENT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERROD SMITH (ADMINISTRATOR)
(832) 344-7488
Entity
Organization
Contact information
Practice address
1229 CREEK WAY DR STE 104, SUGAR LAND, TX 77478-4556
(832) 939-8179
Mailing address
1229 CREEK WAY DR STE 104, SUGAR LAND, TX 77478-4556
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PENDING
DSHS
TX
Enumeration date
12/20/2017
Last updated
12/20/2017
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