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Organization
ROSWELL PROCEDURAL MEDICINE ASSOCIATES
Active
Organization
ROSWELL PROCEDURAL MEDICINE ASSOCIATES
Active
Other names
Southwest Pain Management
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT LOUIS DELILLO C.R.N.A., A.R.N.P. (CEO, CFO)
(817) 966-2762
Entity
Organization
Contact information
Practice address
7451 CHAPEL AVE, FORT WORTH, TX 76116-7090
(817) 294-7444
(817) 423-9060
Mailing address
PO BOX 2626, FORT WORTH, TX 76113-2626
(817) 294-7444
(817) 423-9060
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
514647
TX
367500000X
Certified Registered Nurse Anesthetist
Primary
CRNA-01308
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006995701 (CORP)
—
TX
01
—
00C37J
BCBS (METRO C.R.N.A. SERVICES, INC)
TX
01
—
1013008721
NPI (INDIVIDUAL)
TX
01
—
1245314640
NPI (METRO CRNA SERVICES, INC)
TX
05
—
126047304
—
TX
01
—
84396C
BCBS (PERSONAL)
TX
01
—
8755UE
BCBS
TX
Enumeration date
08/14/2014
Last updated
08/14/2014
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