Organization
HEADACHE AND PAIN AMBULATORY SURGERY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID M FORMAN M.D. (VICE PRESIDENT)
(956) 440-7246
Entity
Organization
Contact information
Practice address
2121 PEASE ST, SUITE 305, HARLINGEN, TX 78550-8349
(956) 440-7246
(956) 440-9517
Mailing address
2121 PEASE ST, SUITE 305, HARLINGEN, TX 78550-8349
(956) 440-7246
(956) 440-9517
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
008099
TX
261QP3300X
Pain Clinic/Center
008099
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
172599601
—
TX
01
—
HH168A
BCBS
TX
Enumeration date
08/20/2006
Last updated
10/05/2009
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