Organization Name: | BLUE STAR PAIN MANAGEMENT LLC |
NPI Number: | 1023300076 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RAE MCGARRITY (COO) |
Mailing Address: | 3000 Corporate Ct Suite 400a Flower Mound |
State: | TX US |
Postal Code: | 750282299 |
Phone Number: | 2146476161 |
Fax Number: | |
NPI Enumeration Date: | 05/10/2011 |
NPI Last Update Date: | 05/10/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR0200X |
License Number: | R34557 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Radiology |
Taxonomy Definition: |