Provider Demographics
NPI:1912214743
Name:NEUROPATHY PAIN CENTERS OF KENNER, LLC
Entity Type:Organization
Organization Name:NEUROPATHY PAIN CENTERS OF KENNER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCT MGR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-860-1005
Mailing Address - Street 1:1184 W PIONEER PKWY
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-6367
Mailing Address - Country:US
Mailing Address - Phone:817-860-1005
Mailing Address - Fax:817-860-5010
Practice Address - Street 1:1919 VETERANS MEMORIAL BLVD STE 102
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70062-4003
Practice Address - Country:US
Practice Address - Phone:504-464-9114
Practice Address - Fax:504-464-9115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty