Provider Demographics
NPI:1710280839
Name:ARAPHAHO INTERVENTIONAL PAIN CENTER, LLC
Entity Type:Organization
Organization Name:ARAPHAHO INTERVENTIONAL PAIN CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TED
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSBECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-362-6909
Mailing Address - Street 1:PO BOX 26168
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-0168
Mailing Address - Country:US
Mailing Address - Phone:972-479-1115
Mailing Address - Fax:972-346-8015
Practice Address - Street 1:1305 AIRPORT FWY
Practice Address - Street 2:SUITE 103
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-6605
Practice Address - Country:US
Practice Address - Phone:972-234-4740
Practice Address - Fax:817-571-0897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-11
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain