| Cowtown Headache Center | |
|
4055 International Plz Ste 660 Fort Worth TX 76109-4874 | |
| (817) 592-8427 | |
| (833) 630-0542 |
| Full Name | Cowtown Headache Center |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 4055 International Plz Ste 660, Fort Worth, Texas |
| Authorized Official Name and Position | Andrew Lavear (OWNER) |
| Authorized Official Contact | 6365750888 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cowtown Headache Center 3912 Homestead Ct Granbury TX 76049-6205 Ph: (636) 575-0888 | Cowtown Headache Center 4055 International Plz Ste 660 Fort Worth TX 76109-4874 Ph: (817) 592-8427 |
| NPI Number | 1720743982 |
|---|---|
| Provider Enumeration Date | 11/03/2021 |
| Last Update Date | 02/20/2023 |
| Certification Date | 02/20/2023 |
| Medicare PECOS PAC ID | 1951778307 |
|---|---|
| Medicare Enrollment ID | O20221027002921 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720743982 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| 363AM0700X | Physician Assistant - Medical | (* (Not Available)) | Secondary |
| Provider Name | Peter J Ocarroll |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1811190812 PECOS PAC ID: 9931252269 Enrollment ID: I20090804000024 |
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