NPIMap

Organization Active NPI

Valor Interventional Pain, LLC

  • Pain Medicine (Anesthesiology) Physician
  • Fort Worth, TX
National Provider Identifier
1104440411
Registry record updated Oct 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
Legal business name
VALOR INTERVENTIONAL PAIN, LLC
Practice address
6620 Bryant Irvin Rd Ste 100
Fort Worth, TX 76132-4224
Phone
(682) 936-2544
NPI assigned
Jun 2, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Bradley J Keneson II, DONPI 1528369592
Title
Owner
Phone
(682) 936-2544

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207L00000X
Pain Medicine (Anesthesiology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207LP2900X Primary

Addresses

Primary practice location

6620 Bryant Irvin Rd Ste 100
Fort Worth, TX 76132-4224

Mailing address

806 Old Cleburne Rd
Granbury, TX 76048-1422
Phone (682) 936-2544

Other identifiers 1

IdentifierTypeStateIssuer
1528369592OtherTXNPI INDIVIDUAL

National Provider Directory

National Provider Directory

Locations

806 Waters Edge Dr
Granbury, TX 76048
Phone (682) 936-2544

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1591056000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603324800000",
    "number": "1104440411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "806 OLD CLEBURNE RD",
            "city": "GRANBURY",
            "state": "TX",
            "postal_code": "760481422",
            "telephone_number": "682-936-2544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6620 BRYANT IRVIN RD STE 100",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761324224",
            "telephone_number": "682-936-2544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VALOR INTERVENTIONAL PAIN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-02",
        "last_updated": "2020-10-22",
        "certification_date": "2020-10-22",
        "status": "A",
        "authorized_official_last_name": "KENESON",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "682-936-2544",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI INDIVIDUAL",
            "identifier": "1528369592",
            "state": "TX"
        }
    ],
    "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 Oct 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.