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Organization

PAIN CARE CENTER LLC

Active
Parent organization
PAIN CARE CENTER LLC
Organization subpart
Yes

Provider details

NPI number
Legal business name
PAIN CARE CENTER LLC
Authorized official
RANDAL CHET RUGER (MANAGING PARTNER)
(307) 267-2116
Entity
Organization

Contact information

Practice address
945 W BROADWAY AVE APT 202, JACKSON, WY 83001-8217
(307) 212-6270
(307) 212-6271
Mailing address
2620 COMMERCIAL WAY STE 20, ROCK SPRINGS, WY 82901-4705
(307) 212-6270

Taxonomy

Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
132443800
WY
Enumeration date
12/03/2020
Last updated
12/03/2020
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