Provider Demographics
NPI:1386662013
Name:THE CENTER FOR PAIN RELIEF TRI STATE PLLC
Entity Type:Organization
Organization Name:THE CENTER FOR PAIN RELIEF TRI STATE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:CARAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-881-2102
Mailing Address - Street 1:100 PEYTON WAY STE 200
Mailing Address - Street 2:THE CENTER FOR PAIN RELIEF TRI STATE PLLC
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-8545
Mailing Address - Country:US
Mailing Address - Phone:904-436-0153
Mailing Address - Fax:904-494-6467
Practice Address - Street 1:100 PEYTON WAY STE 200
Practice Address - Street 2:CPRTS ADMINISTRATIVE OFFICE
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-8545
Practice Address - Country:US
Practice Address - Phone:904-436-0153
Practice Address - Fax:904-494-6467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
163WP0000X, 163WX0800X, 207L00000X, 207LP2900X, 208VP0014X, 363AM0700X, 363L00000X
WV18714208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No163WP0000XNursing Service ProvidersRegistered NursePain ManagementGroup - Multi-Specialty
No163WX0800XNursing Service ProvidersRegistered NurseOrthopedicGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001788761OtherBCBS-ANES. PAY TO #
WV3810004173Medicaid
WVDE2690OtherRR MEDICARE
WV6110073 00OtherFED. WORKER'S COMP
KY65944555Medicaid
WV001813028OtherBCBS-PAIN MGMT. PAY TO #
WV9359501Medicare PIN
WV328955OtherCARELINK
OH2823403Medicaid
WV3000251OtherBRICKSTREET PAY TO #
OH=========OtherOHIO WORKER'S COMP.