MEDICARE: LEAGUE CITY PAIN AND WLLNESS, PLLC

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	208VP0014X	Interventional Pain Medicine Physician
2	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1699417063
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEAGUE CITY PAIN AND WLLNESS, PLLC

Provider Business Mailing Address
First Line	:	3033 MARINA BAY DR STE 120
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-3982
Country	:	US
Telephone Number	:	281-549-6686
Fax Number	:	877-782-0224

Provider Business Practice Location Address
First Line	:	3033 MARINA BAY DR STE 120
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-3982
Country	:	US
Telephone Number	:	281-549-6686
Fax Number	:	877-782-0224

Authorized Official
Title or Position	:	CEO
Name	:	PAUL MURATTA
Credential	:	D.O.
Telephone Number	:	256-504-5232

Provider Enumeration Date	:	04/07/2022
Last Update Date	:	04/07/2022

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