Spine Pain Nm LLC

NPI #1902405657 in Ft Worth, Texas

Provider Information

NPI Number: 1902405657
Entity Type: Organization
Organization Name: Spine Pain Nm LLC
Primary Specialty: Electrodiagnostic Medicine
Enumeration Date: Oct 23, 2020
Last Updated: Oct 23, 2020

Practice Location

Address: 111 BOLAND ST STE 211
City: Ft Worth
State: Texas
ZIP Code: 76107-1265
Phone: (817) 529-8488

Authorized Official

Name: GINA SULLIVAN
Title: PRACTICE ADMINISTRATOE
Phone: (903) 259-0550

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Electrodiagnostic Medicine	204R00000X	Primary

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