Provider Demographics
NPI:1477813582
Name:PAIN RELIEF CENTER,LLC
Entity Type:Organization
Organization Name:PAIN RELIEF CENTER,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:DODIE
Authorized Official - Middle Name:RACHEL
Authorized Official - Last Name:NOLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-488-2101
Mailing Address - Street 1:2925 SISKIYOU BLVD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8179
Mailing Address - Country:US
Mailing Address - Phone:541-773-1435
Mailing Address - Fax:541-858-6828
Practice Address - Street 1:2925 SISKIYOU BLVD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8179
Practice Address - Country:US
Practice Address - Phone:541-773-1435
Practice Address - Fax:541-858-6828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD157375208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty