Provider Demographics
NPI:1831116375
Name:CENTER FOR PAIN RELIEF, INC.
Entity Type:Organization
Organization Name:CENTER FOR PAIN RELIEF, INC.
Other - Org Name:THE SPINE AND NERVE CENTERS OF THE VIRGINIAS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:DEER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-347-6120
Mailing Address - Street 1:400 COURT ST STE 100
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1652
Mailing Address - Country:US
Mailing Address - Phone:304-347-6120
Mailing Address - Fax:304-347-6142
Practice Address - Street 1:400 COURT ST STE 100
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1652
Practice Address - Country:US
Practice Address - Phone:304-347-6120
Practice Address - Fax:304-347-6126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV207LP2900X, 2081P2900X, 208VP0014X, 225100000X, 363AM0700X
363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001710709OtherMSBCBS
WV0011253000Medicaid
WVCI5175OtherRR MEDICARE
WV5544650001Medicare NSC
WV9296571Medicare PIN
WV=========00OtherWORKERS COMP
WV5544650001Medicare NSC
WV=========OtherTRICARE
WV9296571Medicare PIN