Organization
BEDFORD INTERVENTIONAL PAIN CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY WALLS (MANAGER)
(972) 234-4740
Entity
Organization
Contact information
Practice address
1305 AIRPORT FWY, SUITE 103,, BEDFORD, TX 76021-6605
(972) 234-4740
(817) 571-0897
Mailing address
PO BOX 674160, DALLAS, TX 75267-4160
(972) 479-1115
(972) 346-8015
Taxonomy
Speciality
Code
Description
License number
State
261QP3300X
Pain Clinic/Center
—
—
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Enumeration date
06/04/2012
Last updated
06/06/2016
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