Provider Demographics
NPI:1871501023
Name:PAIN CLINIC PA RICHARD K. HURLEY MD
Entity Type:Organization
Organization Name:PAIN CLINIC PA RICHARD K. HURLEY MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:HURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:254-235-4414
Mailing Address - Street 1:405 LONDONDERRY
Mailing Address - Street 2:SUITE #311
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-7922
Mailing Address - Country:US
Mailing Address - Phone:254-235-4414
Mailing Address - Fax:254-235-7378
Practice Address - Street 1:405 LONDONDERRY DR
Practice Address - Street 2:SUITE #311
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-7922
Practice Address - Country:US
Practice Address - Phone:254-235-4414
Practice Address - Fax:254-235-7378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8581207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCE0492OtherRAILROAD MEDICARE
TX0076EROtherBLUE CROSS GROUP
TX1206112-03Medicaid
TX00HA61Medicare ID - Type Unspecified
TXC17247Medicare UPIN
TX6469530001Medicare NSC