Provider Demographics
NPI:1952357980
Name:PIEDMONT PAIN MEDICINE, PC
Entity Type:Organization
Organization Name:PIEDMONT PAIN MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:WINIKUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:434-685-7855
Mailing Address - Street 1:10384 MARTINSVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541
Mailing Address - Country:US
Mailing Address - Phone:434-685-7855
Mailing Address - Fax:434-685-7929
Practice Address - Street 1:10384 MARTINSVILLE HWY
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541
Practice Address - Country:US
Practice Address - Phone:434-685-7855
Practice Address - Fax:434-685-7929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101059090208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA245882OtherBCBS
VA384993OtherBC/BS (ANTHEM) WINIKUR
VA007000057Medicaid
VAE90631Medicare UPIN