Provider Demographics
NPI:1023300076
Name:BLUE STAR PAIN MANAGEMENT LLC
Entity type:Organization
Organization Name:BLUE STAR PAIN MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGARRITY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-647-6161
Mailing Address - Street 1:3000 CORPORATE CT
Mailing Address - Street 2:SUITE 400A
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-2299
Mailing Address - Country:US
Mailing Address - Phone:214-647-6161
Mailing Address - Fax:
Practice Address - Street 1:3000 CORPORATE CT
Practice Address - Street 2:SUITE 400A
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-2299
Practice Address - Country:US
Practice Address - Phone:214-647-6161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR34557261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology