Provider Demographics
NPI:1679995088
Name:BLACKSBURG CENTER FOR PAIN MANAGEMENT, INC.
Entity Type:Organization
Organization Name:BLACKSBURG CENTER FOR PAIN MANAGEMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:BIVINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-605-9773
Mailing Address - Street 1:1901 S MAIN ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-6600
Mailing Address - Country:US
Mailing Address - Phone:540-605-9773
Mailing Address - Fax:540-605-9777
Practice Address - Street 1:1901 S MAIN ST
Practice Address - Street 2:SUITE 8
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-6600
Practice Address - Country:US
Practice Address - Phone:540-605-9773
Practice Address - Fax:540-605-9777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-21
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101029470208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty