Provider Demographics
NPI:1629468269
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:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:H
Authorized Official - Last Name:ALAVI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-479-0050
Mailing Address - Street 1:6210 CAMPBELL RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-1379
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:466 MID CITIES BLVD
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-2430
Practice Address - Country:US
Practice Address - Phone:817-479-0050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-04
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2531332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies