Provider Demographics
NPI:1144756768
Name:PAIN CENTER OF VIRGINIA, PLLC
Entity Type:Organization
Organization Name:PAIN CENTER OF VIRGINIA, PLLC
Other - Org Name:PAIN CENTER OF WEST VIRGINIA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRACTICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LARRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-263-6165
Mailing Address - Street 1:1000 TAVERN RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-2845
Mailing Address - Country:US
Mailing Address - Phone:304-263-6165
Mailing Address - Fax:
Practice Address - Street 1:1839 WEST PLAZA DRIVE
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601
Practice Address - Country:US
Practice Address - Phone:540-773-2689
Practice Address - Fax:540-486-4166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-02
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV252852081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty