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NPI Code Detail

MEDICARE: TRINITY PAIN MEDICINE ASSOCIATES PA

MEDICARE: TRINITY PAIN MEDICINE ASSOCIATES PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208VP0014XInterventional Pain Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10040CGOTHERTXGROUP NUMBER
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1275631459
Entity Type Code : Organization
Provider Name (Legal Business Name) : TRINITY PAIN MEDICINE ASSOCIATES PA
Provider Business Mailing Address
First Line : PO BOX 9290
Second Line :
City : FORT WORTH
State : TX
Zip : 76147-2290
Country : US
Telephone Number : 817-332-3664
Fax Number : 817-336-6440
Provider Business Practice Location Address
First Line : 1401 HENDERSON ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76102-6026
Country : US
Telephone Number : 817-332-3664
Fax Number : 817-336-6440
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : DR. ASHLEY M CLASSEN
Credential : D.O.
Telephone Number : 817-332-3664
Provider Enumeration Date : 09/20/2006
Last Update Date : 01/09/2009

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Directions to “TRINITY PAIN MEDICINE ASSOCIATES PA ” Practice Location

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