Active NPI
Pamela J Mainous
- Surgical Assistant
- Fort Worth, TX
National Provider Identifier
1013431642
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Assistant
- License
- 94494
- Practice address
- 6100 Harris Pkwy
Fort Worth, TX 76132-4101 - Phone
- (817) 346-5000
- NPI assigned
- Jul 25, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Assistant | 246ZC0007X | 94494 | CO | Primary |
Addresses
Primary practice location
6100 Harris Pkwy
Fort Worth, TX 76132-4101
Mailing address
1169 N Burleson Blvd # 107-233
Burleson, TX 76028-7011
Phone (817) 269-1472
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 94494 | CO | MD | Surgical Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1500940800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1500940800000",
"number": "1013431642",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1169 N BURLESON BLVD # 107-233",
"city": "BURLESON",
"state": "TX",
"postal_code": "760287011",
"telephone_number": "817-269-1472",
"fax_number": "817-531-2939"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6100 HARRIS PKWY",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761324101",
"telephone_number": "817-346-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAINOUS",
"first_name": "PAMELA",
"middle_name": "J",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-07-25",
"last_updated": "2017-07-25",
"status": "A"
},
"taxonomies": [
{
"code": "246ZC0007X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other, Surgical Assistant",
"state": "CO",
"license": "94494",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.