Provider Demographics
NPI:1225281835
Name:PHOENIX PAIN INSTITUTE, INC.
Entity Type:Organization
Organization Name:PHOENIX PAIN INSTITUTE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CECIL
Authorized Official - Middle Name:CURTIS
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-575-9943
Mailing Address - Street 1:PO BOX 2396
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25802-2396
Mailing Address - Country:US
Mailing Address - Phone:304-575-9943
Mailing Address - Fax:304-253-5504
Practice Address - Street 1:525 N 18TH ST
Practice Address - Street 2:SUITE 405
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-4102
Practice Address - Country:US
Practice Address - Phone:602-258-7246
Practice Address - Fax:304-253-5504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain