Provider Demographics
NPI:1558651778
Name:PREFERRED PAIN MANAGEMENT
Entity Type:Organization
Organization Name:PREFERRED PAIN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SPIVEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-760-0706
Mailing Address - Street 1:245 CHARLOIS BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1507
Mailing Address - Country:US
Mailing Address - Phone:336-760-0706
Mailing Address - Fax:336-760-1927
Practice Address - Street 1:245 CHARLOIS BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1507
Practice Address - Country:US
Practice Address - Phone:336-760-0706
Practice Address - Fax:336-760-1927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC002049367332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies