MEDICARE: METRO PAIN MANAGEMENT CENTER

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	207LP2900X	Pain Medicine (Anesthesiology) Physician

General Provider Information

NPI Number	:	1861100224
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METRO PAIN MANAGEMENT CENTER

Provider Business Mailing Address
First Line	:	6333 AIRPORT FWY # 102
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76117-5323
Country	:	US
Telephone Number	:	817-834-8214
Fax Number	:

Provider Business Practice Location Address
First Line	:	5701 WESTCREEK DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-3301
Country	:	US
Telephone Number	:	817-834-8214
Fax Number	:	817-923-2913

Authorized Official
Title or Position	:	CFO
Name	:	MR. MICHAEL BROWN
Credential	:
Telephone Number	:	817-834-8214

Provider Enumeration Date	:	11/14/2022
Last Update Date	:	11/14/2022

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