Presidio Pain Center, LLC

Primary specialty

Pain Clinic/CenterTaxonomy code 261QP3300X

Legal business name

PRESIDIO PAIN CENTER, LLC

Practice address

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

Phone

(972) 234-4740

Fax

(972) 231-7095

NPI assigned

Jan 5, 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": "1294185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294185600000",
    "number": "1790089720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 702620",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741702620",
            "telephone_number": "972-234-4740",
            "fax_number": "972-231-7095"
        },
        {
            "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": "972-231-7095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESIDIO PAIN CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-05",
        "last_updated": "2011-01-05",
        "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": []
}

• Premise Health of Texas Medical PA
• Premise Health of Texas Medical PA
• Premise Health of Texas Medical, P.a
• Andrea Prempeh
• Presidio Center Dental PLLC
• Catherine A Presley, LCSW
• Judith Presley, LCDC
• Lisa Marie Presley, RDN, LD
• Mark B Presley, MD
• Rhiannon Baxter Presley, DDS

• 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 5, 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.