Provider Demographics
NPI:1528322807
Name:DUDYCHA PAIN CLINIC PLLC
Entity type:Organization
Organization Name:DUDYCHA PAIN CLINIC PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:DUDYCHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-764-7246
Mailing Address - Street 1:3351 UNIVERSITY DR. E.
Mailing Address - Street 2:SUITE 111
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802
Mailing Address - Country:US
Mailing Address - Phone:979-764-7246
Mailing Address - Fax:979-764-7242
Practice Address - Street 1:3351 UNIVERSITY DR. E.
Practice Address - Street 2:SUITE 111
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802
Practice Address - Country:US
Practice Address - Phone:979-764-7246
Practice Address - Fax:979-764-7242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-01
Last Update Date:2022-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1310261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB159901Medicare PIN