Provider Demographics
NPI:1669438081
Name:KNOW PAIN CLINIC, INC
Entity type:Organization
Organization Name:KNOW PAIN CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CECIL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-252-2100
Mailing Address - Street 1:PO BOX 890471
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28289-0471
Mailing Address - Country:US
Mailing Address - Phone:800-277-8151
Mailing Address - Fax:
Practice Address - Street 1:1902 HARPER RD STE C
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-2642
Practice Address - Country:US
Practice Address - Phone:304-252-2100
Practice Address - Fax:304-252-8200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
151556400OtherUS DEPT OF LABOR
WV001710419OtherMOUNTAIN STATE BCBS
WV0008261000Medicaid
WV9930512Medicare PIN