Provider Demographics
NPI:1982058160
Name:RIVER CITY PAIN MANAGEMENT, PLLC
Entity Type:Organization
Organization Name:RIVER CITY PAIN MANAGEMENT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-709-2344
Mailing Address - Street 1:9819 HUEBNER RD STE 113
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-3253
Mailing Address - Country:US
Mailing Address - Phone:210-692-0101
Mailing Address - Fax:210-692-7615
Practice Address - Street 1:9819 HUEBNER RD STE 113
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-3253
Practice Address - Country:US
Practice Address - Phone:210-692-0101
Practice Address - Fax:210-692-7615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-14
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X, 208VP0000X
TXG6069208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty