Healthcare Provider Details

I. General information

NPI: 1396800223
Provider Name (Legal Business Name): METROPLEX PAIN MANAGEMENT, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 07/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 CENTRAL DR SUITE 160
BEDFORD TX
76022-6000
US

IV. Provider business mailing address

1600 CENTRAL DRIVE SUITE 160
BEDFORD TX
76022-6029
US

V. Phone/Fax

Practice location:
  • Phone: 817-268-0104
  • Fax: 817-268-6102
Mailing address:
  • Phone: 817-268-0104
  • Fax: 817-268-6102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MR. DANNY L STANTON
Title or Position: CFO
Credential:
Phone: 817-268-0104