Provider Demographics
NPI:1912458233
Name:ELITE PAIN MANAGEMENT AND MONITORING
Entity Type:Organization
Organization Name:ELITE PAIN MANAGEMENT AND MONITORING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ALOK
Authorized Official - Middle Name:
Authorized Official - Last Name:KUSHWAHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-581-7246
Mailing Address - Street 1:6805 NE LOOP 820
Mailing Address - Street 2:SUITE 408
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76180-6687
Mailing Address - Country:US
Mailing Address - Phone:817-581-7246
Mailing Address - Fax:817-581-7248
Practice Address - Street 1:6805 NE LOOP 820
Practice Address - Street 2:SUITE 408
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76180-6687
Practice Address - Country:US
Practice Address - Phone:817-581-7246
Practice Address - Fax:817-581-7248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1232207R00000X
TXQ1455208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159213103Medicaid
TXG81130Medicare UPIN
TX612988Medicare PIN