| Organization Name: | BEDFORD INTERVENTIONAL PAIN CENTER, LLC |
| NPI Number: | 1023379211 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TRACY WALLS (MANAGER) |
| Mailing Address: | 1305 Airport Fwy Suite 103, Bedford |
| State: | TX US |
| Postal Code: | 760216605 |
| Phone Number: | 9722344740 |
| Fax Number: | 8175710897 |
| NPI Enumeration Date: | 06/04/2012 |
| NPI Last Update Date: | 06/06/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP3300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Pain |
| Taxonomy Definition: | |