MEDICARE: MANSFIELD PAIN SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP3300X	Pain Clinic/Center		TX

General Provider Information

NPI Number	:	1942797527
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANSFIELD PAIN SERVICES, LLC

Provider Business Mailing Address
First Line	:	10 N CADDO ST # 183
Second Line	:
City	:	CLEBURNE
State	:	TX
Zip	:	76031-5540
Country	:	US
Telephone Number	:	817-703-3714
Fax Number	:

Provider Business Practice Location Address
First Line	:	305 REGENCY PKWY STE 805
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-3794
Country	:	US
Telephone Number	:	817-539-7246
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JOSEPH SCOTT HOUGHTON
Credential	:	CRNA, APRN
Telephone Number	:	903-258-7447

Provider Enumeration Date	:	04/18/2018
Last Update Date	:	01/11/2019

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