Provider Demographics
NPI:1306135629
Name:THE PAIN MANAGEMENT CENTER OF TEXAS
Entity type:Organization
Organization Name:THE PAIN MANAGEMENT CENTER OF TEXAS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-753-7333
Mailing Address - Street 1:3000 ALEMEDA ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-5952
Mailing Address - Country:US
Mailing Address - Phone:817-560-2454
Mailing Address - Fax:817-560-2450
Practice Address - Street 1:3000 ALEMEDA ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-5952
Practice Address - Country:US
Practice Address - Phone:817-560-2454
Practice Address - Fax:817-560-2450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-07
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3712207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty