Organization
MEDICAL CENTRE PAIN MANAGEMENT ASSOCIATES P A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALFREDO L. MARTI MD (PRESIDENT)
(817) 810-0500
Entity
Organization
Contact information
Practice address
1001 12TH AVE STE 170, FORT WORTH, TX 76104-3926
(817) 810-0500
(817) 810-0502
Mailing address
PO BOX 163973, FORT WORTH, TX 76161-3973
(817) 810-0500
(817) 810-0502
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0002JH
BLUE CROSS BLUE SHIELD
TX
Enumeration date
05/09/2006
Last updated
06/29/2012
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