| NPI | 1528603495 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORI A PAYNE Billing Manager 817-953-2968 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine |
| Enumeration Date | 2019-11-14 |
| Last Update Date | 2019-11-14 |