SPINE PAIN NM LLC (NPI# 1902405657) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902405657 |
| Entity Type | Organization |
| Organization Name | SPINE PAIN NM LLC |
| Practice Address |
111 Boland St Ste 211 Ft Worth TX 76107-1265 |
| Practice Telephone | 8175298488 |
| Mailing Telephone | 8175298488 |
| Enumeration Date | 2020-10-23 |
| Last Update Date | 2020-10-23 |
| Authorized Official Name | GINA SULLIVAN (PRACTICE ADMINISTRATOE) |
| Authorized Official Telephone | 9032590550 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 204R00000X | Electrodiagnostic Medicine | Allopathic & Osteopathic Physicians |
| Street Address |
111 BOLAND ST STE 211 |
| City | FT WORTH |
| State | TX |
| Zip Code | 76107-1265 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396133328 | Synapses Iom LLC | Specialist/Technologist, Other | 111 Boland St Ste 211, Ft Worth, TX 76107-1265 | 2014-12-29 |
| 1972104826 | Jacob Dickson | Specialist/Technologist, Other | 111 Boland St Ste 211, Ft Worth, TX 76107-1265 | 2020-11-06 |
| 1063010916 | Andre Ribeiro | Specialist/Technologist, Other | 111 Boland St Ste 211, Ft Worth, TX 76107-1265 | 2020-10-13 |
| 1114524915 | Yvette Ibarra | Specialist/Technologist, Other | 111 Boland St Ste 211, Ft Worth, TX 76107-1265 | 2020-10-05 |
| 1265048458 | Rousseau Iom LLC | Electrodiagnostic Medicine | 111 Boland St Ste 211, Ft Worth, TX 76107-1265 | 2020-09-22 |
| 1306450051 | Mnk Healthcare Monitoring LLC | Electrodiagnostic Medicine | 111 Boland St Ste 211, Ft Worth, TX 76107-1265 | 2020-09-01 |
| 1427673334 | Saspine Consulting LLC | Electrodiagnostic Medicine | 111 Boland St Ste 211, Ft Worth, TX 76107-1265 | 2020-06-16 |
| 1003438524 | Candance Pitts | Specialist/Technologist, Other | 111 Boland St Ste 211, Ft Worth, TX 76107-1265 | 2020-05-07 |
| 1285256701 | Nts Neuromonitring LLC | Electrodiagnostic Medicine | 111 Boland St Ste 211, Ft Worth, TX 76107-1265 | 2020-05-07 |
| 1295357713 | Cory Rahmings | Specialist/Technologist, Other | 111 Boland St Ste 211, Ft Worth, TX 76107-1265 | 2020-05-07 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629683602 | Renovo Wound and Hyperbarics Pllc | Emergency Medicine | 5668 Edwards Ranch Road, Suite 101, Fort Worth, TX 76107 | 2020-09-15 |
| 1669085437 | Ryan Bourgeois | Nurse Practitioner | 2917 Crocket Street, Fort Worth, TX 76107 | 2020-08-31 |
| 1053920546 | Christa Marie Widjaja | Optometrist | 1700 Montgomery St, Fort Worth, TX 76107 | 2020-07-30 |
| 1093351355 | Raymond Iannone | Pharmacist | 850 Montgomery St, Suite #310, Fort Worth, TX 76107 | 2019-11-21 |
| 1053963744 | Cumulus Injury Resolution, Inc. | Chiropractor | 4936 Byers Avenue, Fort Worth, TX 76107 | 2019-07-12 |
| 1770135576 | Shadia Osakwe | Physician Assistant | 855 Montgomery Street, Pediatric Clinic, Fort Worth, TX 76107 | 2019-07-11 |
| 1568945442 | Sachin P Patel | Physical Therapist | 4825 Wellesley St, Fort Worth, TX 76107 | 2018-09-07 |
| 1023594025 | Ftw Pharmacy Services Inc | Durable Medical Equipment & Medical Supplies | 2912 W 6th St Ste 150, Fort Worth, TX 76107 | 2018-07-13 |
| 1669974325 | Helen Williamson Elliott | Counselor | 1751 River Run #217, Fort Worth, TX 76107 | 2018-03-08 |
| 1487156931 | Pelvic Neuromonitoring Pllc | Electrodiagnostic Medicine | 111 Boland St #211, Ft Worth, TX 76107 | 2018-03-01 |
| Find all providers in zip 76107 | ||||
| Taxonomy Code | 204R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Electrodiagnostic Medicine |
| Electrodiagnostic medicine is the medical subspecialty that applies neurophysiologic techniques to diagnose, evaluate, and treat patients with impairments of the neurologic, neuromuscular, and/or muscular systems. Qualified physicians are trained in performing electrophysiological testing and interpretation of the test data. They require knowledge in anatomy, physiology, kinesiology, histology, and pathology of the brain, spinal cord, autonomic nerves, cranial nerves, peripheral nerves, neuromuscular junction, and muscles. They must know clinical features and treatment of diseases of the central, peripheral, and autonomic nervous systems, as well as those of neuromuscular junction and muscle. Physicians also require special knowledge about electric signal processing, including waveform analysis, electronics and instrumentation, stimulation and recording equipment, and statistics. |
| Notes: Source: American Association of Neuromuscular & Electrodiagnostic Medicine, 2011. www.aanem.org [1/1/2011: new] Additional Resources: American Board of Electrodiagnostic Medicine, 2011. www.abemexam.org |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487156931 | Pelvic Neuromonitoring Pllc | Electrodiagnostic Medicine | 111 Boland St #211, Ft Worth, TX 76107 | 2018-03-01 |
| 1538518972 | Eminent Electrophysiological Logistics LLC | Electrodiagnostic Medicine | 111 Boland St, 211, Ft Worth, TX 76107-1263 | 2016-06-07 |
| 1265048458 | Rousseau Iom LLC | Electrodiagnostic Medicine | 111 Boland St Ste 211, Ft Worth, TX 76107-1265 | 2020-09-22 |
| 1306450051 | Mnk Healthcare Monitoring LLC | Electrodiagnostic Medicine | 111 Boland St Ste 211, Ft Worth, TX 76107-1265 | 2020-09-01 |
| 1427673334 | Saspine Consulting LLC | Electrodiagnostic Medicine | 111 Boland St Ste 211, Ft Worth, TX 76107-1265 | 2020-06-16 |
| 1285256701 | Nts Neuromonitring LLC | Electrodiagnostic Medicine | 111 Boland St Ste 211, Ft Worth, TX 76107-1265 | 2020-05-07 |
| 1902425754 | Guidance Diagnostic LLC | Electrodiagnostic Medicine | 111 Boland St Ste 211, Ft Worth, TX 76107-1265 | 2020-04-13 |
| 1932735164 | Pek Medical So;utions Pllc | Electrodiagnostic Medicine | 111 Boland St Ste 211, Ft Worth, TX 76107-1265 | 2020-03-19 |
| 1811521537 | Texas Standard Medical Pllc | Electrodiagnostic Medicine | 111 Boland St Ste 211, Ft Worth, TX 76107-1265 | 2020-03-03 |
| 1942849161 | Ahv Iom LLC | Electrodiagnostic Medicine | 111 Boland St Ste 211, Ft Worth, TX 76107-1265 | 2020-01-06 |
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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.