Provider Demographics
NPI:1073094967
Name:VALOR INTERVENTIONAL PAIN, LLC
Entity Type:Organization
Organization Name:VALOR INTERVENTIONAL PAIN, LLC
Other - Org Name:VALOR PAIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:KENESON
Authorized Official - Suffix:II
Authorized Official - Credentials:DO
Authorized Official - Phone:682-936-2544
Mailing Address - Street 1:806 OLD CLEBURNE RD
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-1422
Mailing Address - Country:US
Mailing Address - Phone:682-936-2544
Mailing Address - Fax:
Practice Address - Street 1:806 OLD CLEBURNE RD
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-1422
Practice Address - Country:US
Practice Address - Phone:682-936-2544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-28
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty