Basic Information
| Provider Information | |||||||||
| NPI: | 1548757545 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | QUANTUM PAIN AND ORTHOPEDIC, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8626 TESORO DR STE 112 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782176217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2108176010 | ||||||||
| FaxNumber: | 2108176011 | ||||||||
| Practice Location | |||||||||
| Address1: | 8626 TESORO DR STE 112 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782176217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2108176010 | ||||||||
| FaxNumber: | 2108176011 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2018 | ||||||||
| LastUpdateDate: | 06/16/2018 | ||||||||
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| AuthorizedOfficialLastName: | LI | ||||||||
| AuthorizedOfficialFirstName: | SAM | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2108176010 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | R4868 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1336403864 | 01 | TX | ALL OTHER INSURANCE | OTHER |