Provider Demographics
NPI:1184662769
Name:VIRGINIA INTERVENTIONAL PAIN SPECIALISTS, PC
Entity type:Organization
Organization Name:VIRGINIA INTERVENTIONAL PAIN SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-282-6160
Mailing Address - Street 1:PO BOX 1269
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-8269
Mailing Address - Country:US
Mailing Address - Phone:804-282-6160
Mailing Address - Fax:804-282-3120
Practice Address - Street 1:7603 FOREST AVE
Practice Address - Street 2:COURTYARD BUILDING, HENRICO DRS. HOSPITAL
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4944
Practice Address - Country:US
Practice Address - Phone:804-282-6160
Practice Address - Fax:804-282-3120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101040954174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAF65054Medicare UPIN