PRESIDIO PAIN CENTER, LLC (NPI# 1790089720) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790089720 |
| Entity Type | Organization |
| Organization Name | PRESIDIO PAIN CENTER, LLC |
| Practice Address |
1201 Summit Ave Suite 400 Fort Worth TX 76102-4413 |
| Mailing Address |
Po Box 702620 Tulsa OK 74170-2620 |
| Practice Telephone | 9722344740 |
| Practice Fax Number | 9722317095 |
| Mailing Telephone | 9722344740 |
| Mailing Fax Number | 9722317095 |
| Enumeration Date | 2011-01-05 |
| Last Update Date | 2011-01-05 |
| Authorized Official Name | TED GROSBECK (MANAGER) |
| Authorized Official Telephone | 4693626909 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP3300X |
Clinic/Center Specialization: Pain |
Ambulatory Health Care Facilities |
| Street Address |
1201 SUMMIT AVE SUITE 400 |
| City | FORT WORTH |
| State | TX |
| Zip Code | 76102-4413 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881690279 | Aziz Samir Abdul-rahim | Ophthalmology | 1201 Summit Ave, Fort Worth, TX 76102-4427 | 2005-06-22 |
| 1891313037 | Jordan L Haney | Nurse Practitioner | 1201 Summit Ave, Fort Worth, TX 76102-4413 | 2020-07-13 |
| 1487073953 | Derek Yang Han | Ophthalmology | 1201 Summit Ave, Fort Worth, TX 76102-4413 | 2014-04-14 |
| 1679991053 | Tina Chen | Ophthalmology | 1201 Summit Ave, Fort Worth, TX 76102-4413 | 2014-04-02 |
| 1942634662 | Harper Interventional Pain Center LLC | Clinic/Center | 1201 Summit Ave, Suite 400, Fort Worth, TX 76102-4413 | 2013-08-29 |
| 1356685861 | Marsh Interventional Pain Center, LLC | Clinic/Center | 1201 Summit Ave, Suite 400, Fort Worth, TX 76102-4413 | 2012-11-21 |
| 1265701767 | Judy Marie Myers | Optometrist | 1201 Summit Ave, Fort Worth, TX 76102-4413 | 2011-12-29 |
| 1124310073 | Penn Interventional Pain Center, LLC | Clinic/Center | 1201 Summit Ave, Suite 400, Fort Worth, TX 76102-4413 | 2011-05-11 |
| 1295045854 | Summit Avenue Pain Center, LLC | Clinic/Center | 1201 Summit Ave, Suite 400, Fort Worth, TX 76102-4413 | 2010-10-18 |
| 1376863662 | Unni Krishnan Nair | Ophthalmology | 1201 Summit Ave, Fort Worth, TX 76102-4413 | 2010-06-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285113746 | Deirdre P Browne | Counselor | 1500 E El Paso, Fort Worth, TX 76102 | 2018-08-07 |
| 1740784206 | Cvs Pharmacy Inc | Pharmacy | 515 Houston St, Fort Worth, TX 76102 | 2018-03-20 |
| 1316448061 | Diondra Deshawn Narcisse | Licensed Vocational Nurse | 1314 Lake Street, Fort Worth, TX 76102 | 2018-02-27 |
| 1649779943 | Carmela A Solis | Specialist/Technologist, Other | 500 Throckmorton Street Unit 3309, Fort Worth, TX 76102 | 2018-02-02 |
| 1104324516 | Vicki Webb-baker | Health Educator | 512 Lamar Street, Suite 400, Fort Worth, TX 76102 | 2018-01-31 |
| 1235647678 | Brianna Marie Keister | Occupational Therapist | 201 W. Lancaster Ave, 417, Fort Worth, TX 76102 | 2018-01-19 |
| 1437507910 | Medical Hearing Services, LLC | Hearing Aid Equipment | 1201 Summit Avenue, Fort Worth, TX 76102 | 2016-05-25 |
| 1891171476 | Karis Starke | Physical Therapy Assistant | 2500 West Freeway (i-30), 100, Fort Worth, TX 76102 | 2015-08-05 |
| 1265839344 | Fm Katy Dental and Orthodontics, Pllc | Dentist | 100 E 15th Ste 520, Fort Worth, TX 76102 | 2014-12-04 |
| 1093134512 | Superior Evaluation Services | General Practice | 420 Throckmorton Suite 200, Ft. Worth, TX 76102 | 2014-04-11 |
| Find all providers in zip 76102 | ||||
| Taxonomy Code | 261QP3300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Pain |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093205858 | Evolution Pain Centers LLC | Clinic/Center | 6789 Camp Bowie Blvd, Fort Worth, TX 76116-7112 | 2018-05-16 |
| 1922457035 | Maple Anesthesia Management, LLC | Clinic/Center | 2001 Cooper St, Fort Worth, TX 76104-2529 | 2016-06-09 |
| 1093164196 | Spruce Anesthesia Management, LLC | Clinic/Center | 2001 Cooper St, Fort Worth, TX 76104-2529 | 2016-06-09 |
| 1902255003 | Elm Anesthesia Management, LLC | Clinic/Center | 2001 Cooper St, Fort Worth, TX 76104-2529 | 2016-06-09 |
| 1255786786 | Hatch Anesthesia Management LLC | Clinic/Center | 2001 Cooper St, Fort Worth, TX 76104-2529 | 2016-05-03 |
| 1609237072 | Eames Pain and Anesthesia Management | Clinic/Center | 1301 N Beach St, Fort Worth, TX 76111-6613 | 2016-03-14 |
| 1093190803 | Elite Pain Management & Monitoring | Clinic/Center | 6805 Ne Loop 820, Suite 408, Fort Worth, TX 76180-6687 | 2015-07-22 |
| 1356720718 | Texas Health Care Pain Management | Clinic/Center | 1307 8th Ave, Suite 506, Fort Worth, TX 76104-4137 | 2015-05-19 |
| 1003216649 | Texas Varicose Vein Clinic of Fort Worth, LLC | Clinic/Center | 1106 Alston Ave, Ste 200, Fort Worth, TX 76104-4644 | 2014-09-02 |
| 1942634662 | Harper Interventional Pain Center LLC | Clinic/Center | 1201 Summit Ave, Suite 400, Fort Worth, TX 76102-4413 | 2013-08-29 |
| Find all providers in FORT WORTH | ||||
| City | FORT WORTH |
| Zip Code | 76102 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.