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NPI Code Detail

MEDICARE: MEDICAL CENTRE PAIN MANAGEMENT ASSOCIATES P A

MEDICARE: MEDICAL CENTRE PAIN MANAGEMENT ASSOCIATES P A
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
1363L00000XNurse Practitioner
2207LP2900XPain Medicine (Anesthesiology) Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10002JHOTHERTXBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1902855521
Entity Type Code : Organization
Provider Name (Legal Business Name) : MEDICAL CENTRE PAIN MANAGEMENT ASSOCIATES P A
Provider Business Mailing Address
First Line : PO BOX 163973
Second Line :
City : FORT WORTH
State : TX
Zip : 76161-3973
Country : US
Telephone Number : 817-810-0500
Fax Number : 817-810-0502
Provider Business Practice Location Address
First Line : 1001 12TH AVE STE 170
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-3926
Country : US
Telephone Number : 817-810-0500
Fax Number : 817-810-0502
Authorized Official
Title or Position : PRESIDENT
Name : ALFREDO L. MARTI
Credential : MD
Telephone Number : 817-810-0500
Provider Enumeration Date : 05/09/2006
Last Update Date : 06/29/2012

Similar Medicare Providers

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Practice Location Address:
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1114919172 — HEALTH TEXAS PROVIDER NETWORK-FAMILY PRACTICE OF NORTH TEXAS LLP
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1770576894 — DR. TANA RAELIZABETH DONNELL PHARM D.
Practice Location Address:
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Practice Phone: 817-850-2090
Practice Fax:
1538152400 — DR. DIANA ELIZABETH WILSON M.D.
Practice Location Address:
1001 12TH AVE STE 171
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1922072479 — ALAN E ROBBINS DPM
Practice Location Address:
1001 12TH AVE , STE 104
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Practice Fax: 817-336-6503

Directions to “MEDICAL CENTRE PAIN MANAGEMENT ASSOCIATES P A ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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