Provider Demographics
NPI:1275631459
Name:TRINITY PAIN MEDICINE ASSOCIATES PA
Entity Type:Organization
Organization Name:TRINITY PAIN MEDICINE ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:CLASSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-332-3664
Mailing Address - Street 1:PO BOX 9290
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76147-2290
Mailing Address - Country:US
Mailing Address - Phone:817-332-3664
Mailing Address - Fax:817-336-6440
Practice Address - Street 1:1401 HENDERSON ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-6026
Practice Address - Country:US
Practice Address - Phone:817-332-3664
Practice Address - Fax:817-336-6440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0040CGOtherGROUP NUMBER
TX079577501Medicaid
TX00020FMedicare ID - Type UnspecifiedGROUP NUMBER
TXD70572Medicare UPIN