MEDICARE: MD PAIN CLINIC, INC.

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	261QH0100X	Health Service Clinic/Center	DC5030	TX

General Provider Information

NPI Number	:	1528259322
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MD PAIN CLINIC, INC.

Provider Business Mailing Address
First Line	:	2004 BOTTS DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76012-1817
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2406 W SEMINARY DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76115-1917
Country	:	US
Telephone Number	:	817-261-0704
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAMES DAVID ALEXANDER
Credential	:	DC
Telephone Number	:	817-228-1522

Provider Enumeration Date	:	08/06/2007
Last Update Date	:	08/06/2007

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