Healthcare Provider Details

I. General information

NPI: 1275631459
Provider Name (Legal Business Name): TRINITY PAIN MEDICINE ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 01/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 HENDERSON ST
FORT WORTH TX
76102-6026
US

IV. Provider business mailing address

PO BOX 9290
FORT WORTH TX
76147-2290
US

V. Phone/Fax

Practice location:
  • Phone: 817-332-3664
  • Fax: 817-336-6440
Mailing address:
  • Phone: 817-332-3664
  • Fax: 817-336-6440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ASHLEY M CLASSEN
Title or Position: MEDICAL DIRECTOR
Credential: D.O.
Phone: 817-332-3664