Provider Demographics
NPI:1376028225
Name:PAIN CARE CENTER, LLC
Entity Type:Organization
Organization Name:PAIN CARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHET
Authorized Official - Middle Name:
Authorized Official - Last Name:RUGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-212-6270
Mailing Address - Street 1:2620 COMMERCIAL WAY STE 20
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-4705
Mailing Address - Country:US
Mailing Address - Phone:130-721-2627
Mailing Address - Fax:
Practice Address - Street 1:5850 E 2ND ST UNIT 100
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-4343
Practice Address - Country:US
Practice Address - Phone:307-212-6270
Practice Address - Fax:307-212-6271
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAIN CARE CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPainGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTIN