Henderson Interventional Pain Center, LLC

Primary specialty

Pain Clinic/CenterTaxonomy code 261QP3300X

Legal business name

HENDERSON INTERVENTIONAL PAIN CENTER, LLC

Practice address

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

Phone

(817) 334-0990

Fax

(817) 571-0897

NPI assigned

Jan 7, 2013

Last updated

Jan 7, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tracy Walls

Title

President

Phone

(972) 234-4740

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1357516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1357516800000",
    "number": "1184961583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 674001",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752674001",
            "telephone_number": "972-479-1115",
            "fax_number": "972-346-8015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 SUMMIT AVE",
            "address_2": "SUITE 400",
            "city": "FT WORTH",
            "state": "TX",
            "postal_code": "761024413",
            "telephone_number": "817-334-0990",
            "fax_number": "817-571-0897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HENDERSON INTERVENTIONAL PAIN CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-07",
        "last_updated": "2013-01-07",
        "status": "A",
        "authorized_official_last_name": "WALLS",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "972-234-4740"
    },
    "taxonomies": [
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angela Hembree
• Jessica Hembree, DO
• Jessie Leah Hempstead, PA
• Aya Hendawy, RPH
• Laura Lee Hendee, PTA
• Henderson Optical (Cityview Optical)
• Henderson Optical, LLC
• Yolanda Denise Henderson-Chambers, RN
• Candance Henderson
• Davetta A Henderson, PSYD, LMHC

• 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 Jan 7, 2013; 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.