MEDICARE: OPEDIA HEALTH LLC

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
1	2084P2900X	Pain Medicine (Psychiatry & Neurology) Physician
2	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1548841349
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPEDIA HEALTH LLC

Provider Business Mailing Address
First Line	:	3345 WESTERN CENTER BLVD STE 160
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-1938
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3345 WESTERN CENTER BLVD STE 160
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-1938
Country	:	US
Telephone Number	:	817-381-9650
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MANU MATHEWS
Credential	:	MD
Telephone Number	:	817-381-9650

Provider Enumeration Date	:	04/14/2021
Last Update Date	:	04/14/2021

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Directions to “OPEDIA HEALTH LLC ” Practice Location

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