Provider Demographics
NPI:1447561691
Name:NEUROPATHY PAIN CLINIC OF FORT WORTH LLC
Entity Type:Organization
Organization Name:NEUROPATHY PAIN CLINIC OF FORT WORTH LLC
Other - Org Name:DFW NEUROPATHY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:ALAVI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:682-323-5904
Mailing Address - Street 1:919 W RANDOL MILL RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-2511
Mailing Address - Country:US
Mailing Address - Phone:682-323-5904
Mailing Address - Fax:682-323-4139
Practice Address - Street 1:919 W RANDOL MILL RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-2511
Practice Address - Country:US
Practice Address - Phone:682-323-5904
Practice Address - Fax:682-323-4139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-23
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0008TXOtherBCBSTX
TX6443020001Medicare NSC
TXTXB114242Medicare PIN