Provider Demographics
NPI:1558505909
Name:GRAPEVINE PAIN MANAGEMENT, LLC
Entity Type:Organization
Organization Name:GRAPEVINE PAIN MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:S
Authorized Official - Last Name:MAYFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-479-0800
Mailing Address - Street 1:5750 RUFE SNOW DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-6163
Mailing Address - Country:US
Mailing Address - Phone:817-479-0800
Mailing Address - Fax:817-479-0801
Practice Address - Street 1:2401 IRA E WOODS AVE
Practice Address - Street 2:SUITE 700
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3997
Practice Address - Country:US
Practice Address - Phone:817-488-9991
Practice Address - Fax:817-488-9992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-29
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain