Provider Demographics
NPI:1750443693
Name:METROPLEX PAIN MANAGEMENT, P.A.
Entity type:Organization
Organization Name:METROPLEX PAIN MANAGEMENT, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:L
Authorized Official - Last Name:STANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-268-0104
Mailing Address - Street 1:1600 CENTRAL DR
Mailing Address - Street 2:SUITE 160
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-6000
Mailing Address - Country:US
Mailing Address - Phone:817-268-0104
Mailing Address - Fax:817-268-6102
Practice Address - Street 1:1600 CENTRAL DR
Practice Address - Street 2:SUITE 160
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6000
Practice Address - Country:US
Practice Address - Phone:817-268-0104
Practice Address - Fax:817-268-6102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00N75TOtherBLUE CROSS BLUE SHIELD
KY180403400OtherDEPARTMENT OF LABOR
OH203080OtherEEOICP WORK COMP
CN7626OtherRAILROAD MEDICARE
TX090101902Medicaid
OH203080OtherEEOICP WORK COMP