Basic Information
| Provider Information | |||||||||
| NPI: | 1356720718 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TEXAS HEALTH CARE PAIN MANAGEMENT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1307 8TH AVE | ||||||||
| Address2: | SUITE 506 | ||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761044137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173326092 | ||||||||
| FaxNumber: | 8173326015 | ||||||||
| Practice Location | |||||||||
| Address1: | 1307 8TH AVE | ||||||||
| Address2: | SUITE 506 | ||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761044137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173326092 | ||||||||
| FaxNumber: | 8173326015 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2015 | ||||||||
| LastUpdateDate: | 05/19/2015 | ||||||||
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| AuthorizedOfficialLastName: | RATINO | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | MICHAEL | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8173326092 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP3300X | M7558 | TX | Y | Ambulatory Health Care Facilities | Clinic/Center | Pain |
No ID Information.