Organization
PROVENTIAL MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK FILLEY MD (DIRECTOR)
(281) 543-0012
Entity
Organization
Contact information
Practice address
21300 PROVINCIAL BLVD, SUITE 200, KATY, TX 77450
(713) 562-7890
(281) 605-4566
Mailing address
10507 E WILDWIND CIR, SPRING, TX 77380-4043
(281) 543-0012
(281) 605-4566
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
—
—
Other
Enumeration date
09/21/2018
Last updated
09/21/2018
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