Provider Demographics
NPI:1659919017
Name:SHENANDOAH PAIN AND PALLIATIVE CARE CLINIC, LLC
Entity Type:Organization
Organization Name:SHENANDOAH PAIN AND PALLIATIVE CARE CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TABITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:540-901-7028
Mailing Address - Street 1:173 E SPRINGBROOK RD UNIT 3
Mailing Address - Street 2:
Mailing Address - City:BROADWAY
Mailing Address - State:VA
Mailing Address - Zip Code:22815-9526
Mailing Address - Country:US
Mailing Address - Phone:540-901-7028
Mailing Address - Fax:540-901-2599
Practice Address - Street 1:173 E. SPRINGBROOK ROAD
Practice Address - Street 2:UNIT 3
Practice Address - City:BROADWAY
Practice Address - State:VA
Practice Address - Zip Code:22815
Practice Address - Country:US
Practice Address - Phone:540-901-7028
Practice Address - Fax:540-901-2599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-17
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty