Organization
FREEDOM PAIN CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OLLIS C JOHNSON C.R.N.A. (OWNER)
(817) 294-7444
Entity
Organization
Contact information
Practice address
918 N DAVIS DR, ARLINGTON, TX 76012-3226
(817) 860-9933
Mailing address
7451 CHAPEL AVE, FORT WORTH, TX 76116-7090
(817) 294-7444
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
228850
TX
367500000X
Certified Registered Nurse Anesthetist
Primary
228850
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00C18V
BLUE CROSS BLUE SHIELD
TX
Enumeration date
09/27/2006
Last updated
11/07/2011
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