Penn Interventional Pain Center, LLC

Primary specialty

Pain Clinic/CenterTaxonomy code 261QP3300X

Legal business name

PENN INTERVENTIONAL PAIN CENTER, LLC

Practice address

1201 Summit Ave
Suite 400
Fort Worth, TX 76102-4413

Phone

(972) 234-4740

Fax

(817) 571-0897

NPI assigned

May 11, 2011

Organization subpart

No

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

Authorized official

Name

Ted Grosbeck

Title

Manager

Phone

(469) 362-6909

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1305072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1305072000000",
    "number": "1124310073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 268934",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731268934",
            "telephone_number": "972-234-4740",
            "fax_number": "817-571-0897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 SUMMIT AVE",
            "address_2": "SUITE 400",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761024413",
            "telephone_number": "972-234-4740",
            "fax_number": "817-571-0897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENN INTERVENTIONAL PAIN CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-11",
        "last_updated": "2011-05-11",
        "status": "A",
        "authorized_official_last_name": "GROSBECK",
        "authorized_official_first_name": "TED",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "469-362-6909"
    },
    "taxonomies": [
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Silvia Dayana Pena, RN
• John T Pender Jr., MD
• Marisa Pendery
• Monica Peng, MD
• Penguin Medical Supplies, Inc
• Makayla Marie Penner, MD
• Michael William Penney, MD
• Taylor Penning
• Emily M Penninger, PNP
• Mark Penninger, FNP

• Pain Clinic/Center in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Pain Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2011; 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.