Provider Demographics
NPI:1326376930
Name:PAIN CLINIC, PLLC
Entity Type:Organization
Organization Name:PAIN CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:G.
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:DYER
Authorized Official - Suffix:
Authorized Official - Credentials:M,D
Authorized Official - Phone:910-547-3484
Mailing Address - Street 1:1201 S 16TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-6419
Mailing Address - Country:US
Mailing Address - Phone:910-547-3484
Mailing Address - Fax:910-547-3484
Practice Address - Street 1:1201 S 16TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6419
Practice Address - Country:US
Practice Address - Phone:910-547-3484
Practice Address - Fax:910-547-3484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-20
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain