Provider Demographics
NPI:1245644533
Name:PAIN CENTER OF THE BLUE RIDGE
Entity type:Organization
Organization Name:PAIN CENTER OF THE BLUE RIDGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MURRAY
Authorized Official - Middle Name:E
Authorized Official - Last Name:JOINER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:540-904-7771
Mailing Address - Street 1:PO BOX 21435
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018
Mailing Address - Country:US
Mailing Address - Phone:540-904-7771
Mailing Address - Fax:540-904-7791
Practice Address - Street 1:4521 BRAMBLETON AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018
Practice Address - Country:US
Practice Address - Phone:540-904-7771
Practice Address - Fax:540-904-7791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101046633208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty