Provider Demographics
NPI:1427562891
Name:MIDCOUNTY PAIN SERVICES, LLC
Entity type:Organization
Organization Name:MIDCOUNTY PAIN SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCHUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:507-398-2067
Mailing Address - Street 1:PO BOX 1245
Mailing Address - Street 2:
Mailing Address - City:PORT NECHES
Mailing Address - State:TX
Mailing Address - Zip Code:77651-1245
Mailing Address - Country:US
Mailing Address - Phone:507-398-2067
Mailing Address - Fax:
Practice Address - Street 1:3610 STAGG DR
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-3739
Practice Address - Country:US
Practice Address - Phone:409-923-0012
Practice Address - Fax:409-291-8010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-21
Last Update Date:2022-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP2493OtherSTATELICENSE