Healthcare Provider Details

I. General information

NPI: 1609237072
Provider Name (Legal Business Name): EAMES PAIN AND ANESTHESIA MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2016
Last Update Date: 03/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 N BEACH ST
FORT WORTH TX
76111-6613
US

IV. Provider business mailing address

508 WOODSTREAM PL
MESQUITE TX
75149-5874
US

V. Phone/Fax

Practice location:
  • Phone: 817-831-3388
  • Fax: 817-831-1541
Mailing address:
  • Phone: 214-683-7838
  • Fax: 972-216-4481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License NumberHO319
License Number StateTX

VIII. Authorized Official

Name: DR. BRADLEY JOHN EAMES
Title or Position: PRESIDENT
Credential: D.O.
Phone: 214-683-7838