MEDICARE: CAREFIRST MEDICAL ASSOCIATES AND PAIN REHABILITATION, 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	111N00000X	Chiropractor
2	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DF1536	OTHER	TX	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1780817866	OTHER	TX	BCBSTX

General Provider Information

NPI Number	:	1780817866
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAREFIRST MEDICAL ASSOCIATES AND PAIN REHABILITATION, PA

Provider Business Mailing Address
First Line	:	403 STATE HIGHWAY 110 N
Second Line	:
City	:	WHITEHOUSE
State	:	TX
Zip	:	75791-3109
Country	:	US
Telephone Number	:	903-839-1000
Fax Number	:	903-839-4000

Provider Business Practice Location Address
First Line	:	3704 ALTA MESA BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-5606
Country	:	US
Telephone Number	:	817-423-4440
Fax Number	:	817-423-4441

Authorized Official
Title or Position	:	PHYSICIAN-PRESIDENT
Name	:	DR. RANDALL W RODGERS
Credential	:	D.O.
Telephone Number	:	903-839-1000

Provider Enumeration Date	:	08/24/2009
Last Update Date	:	01/04/2011

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Directions to “CAREFIRST MEDICAL ASSOCIATES AND PAIN REHABILITATION, PA ” Practice Location

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