Provider Demographics
NPI:1902569445
Name:FORT WORTH INTERVENTIONAL LLC
Entity Type:Organization
Organization Name:FORT WORTH INTERVENTIONAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:RATINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-332-6092
Mailing Address - Street 1:1307 8TH AVE STE 506
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4142
Mailing Address - Country:US
Mailing Address - Phone:817-332-6092
Mailing Address - Fax:
Practice Address - Street 1:1307 8TH AVE STE 506
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4142
Practice Address - Country:US
Practice Address - Phone:817-332-6092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FORT WORTH INTERVENTIONAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty