1356720718 NPI number — TEXAS HEALTH CARE PAIN MANAGEMENT

Table of content: DR. SUJAY KIRAN SHETH M.D. (NPI 1669733184)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356720718 NPI number — TEXAS HEALTH CARE PAIN MANAGEMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEXAS HEALTH CARE PAIN MANAGEMENT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356720718
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1307 8TH AVE
Provider Second Line Business Mailing Address:
SUITE 506
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76104-4137
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-332-6092
Provider Business Mailing Address Fax Number:
817-332-6015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1307 8TH AVE
Provider Second Line Business Practice Location Address:
SUITE 506
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76104-4137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-332-6092
Provider Business Practice Location Address Fax Number:
817-332-6015
Provider Enumeration Date:
05/19/2015

Additional Information

Authorized Official

Authorized Official Last Name:
RATINO
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
817-332-6092

Provider Taxonomy Codes

  • Taxonomy code: 261QP3300X , with the licence number:  M7558 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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