Provider Demographics
NPI:1205583754
Name:PAIN MANAGEMENT OF SWVA, INC.
Entity type:Organization
Organization Name:PAIN MANAGEMENT OF SWVA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:N
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-883-5800
Mailing Address - Street 1:PO BOX 2004
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:VA
Mailing Address - Zip Code:24266-2004
Mailing Address - Country:US
Mailing Address - Phone:276-219-9595
Mailing Address - Fax:
Practice Address - Street 1:1190 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:VA
Practice Address - Zip Code:24266-5014
Practice Address - Country:US
Practice Address - Phone:276-883-5800
Practice Address - Fax:276-883-5850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-04
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain