Basic Information
| Provider Information | |||||||||
| NPI: | 1215418678 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EDWARD BAUMGARTNER JR MD LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | TEXAS INTERVENTIONAL PAIN SPECIALISTS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17314 STATE HIGHWAY 249 STE 100 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770641100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8329607160 | ||||||||
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| Practice Location | |||||||||
| Address1: | 17314 STATE HIGHWAY 249 STE 100 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7139737246 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2018 | ||||||||
| LastUpdateDate: | 02/28/2022 | ||||||||
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| AuthorizedOfficialLastName: | BAUMGARTNER | ||||||||
| AuthorizedOfficialFirstName: | EDWARD | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8329607160 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 02/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
No ID Information.