MEDICARE: TRICITY PAIN 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
1	207L00000X	Anesthesiology Physician
2	208VP0014X	Interventional Pain Medicine Physician

General Provider Information

NPI Number	:	1356965131
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRICITY PAIN ASSOCIATES PA

Provider Business Mailing Address
First Line	:	19141 STONE OAK PKWY STE 104
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-3367
Country	:	US
Telephone Number	:	210-268-0129
Fax Number	:	210-314-4609

Provider Business Practice Location Address
First Line	:	4325 N JOSEY LN STE 206
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75010-4637
Country	:	US
Telephone Number	:	972-939-7246
Fax Number	:	210-314-4609

Authorized Official
Title or Position	:	CEO
Name	:	URFAN AHMAD DAR
Credential	:	MD
Telephone Number	:	210-268-0129

Provider Enumeration Date	:	06/08/2020
Last Update Date	:	06/08/2020

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Directions to “TRICITY PAIN ASSOCIATES PA ” Practice Location

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