Provider Demographics
NPI:1780817866
Name:CAREFIRST MEDICAL ASSOCIATES AND PAIN REHABILITATION, PA
Entity Type:Organization
Organization Name:CAREFIRST MEDICAL ASSOCIATES AND PAIN REHABILITATION, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:W
Authorized Official - Last Name:RODGERS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:903-839-1000
Mailing Address - Street 1:403 STATE HIGHWAY 110 N
Mailing Address - Street 2:
Mailing Address - City:WHITEHOUSE
Mailing Address - State:TX
Mailing Address - Zip Code:75791-3109
Mailing Address - Country:US
Mailing Address - Phone:903-839-1000
Mailing Address - Fax:903-839-4000
Practice Address - Street 1:3704 ALTA MESA BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-5606
Practice Address - Country:US
Practice Address - Phone:817-423-4440
Practice Address - Fax:817-423-4441
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAREFIRST MEDICAL ASSOCIATES AND PAIN REHABILITATION, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-24
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1780817866OtherBCBSTX
TXDF1536OtherRAILROAD MEDICARE
TXDF1536OtherRAILROAD MEDICARE