Provider Demographics
NPI:1063654689
Name:FIBROMYALGIS AND CHRONIC PAIN ASSOCS.
Entity Type:Organization
Organization Name:FIBROMYALGIS AND CHRONIC PAIN ASSOCS.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:HUSE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:254-445-2404
Mailing Address - Street 1:402 HOFFMAN DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:TX
Mailing Address - Zip Code:76446-1120
Mailing Address - Country:US
Mailing Address - Phone:254-445-2404
Mailing Address - Fax:
Practice Address - Street 1:402 HOFFMAN DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:TX
Practice Address - Zip Code:76446-1120
Practice Address - Country:US
Practice Address - Phone:254-445-2404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC2405171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty