Healthcare Provider Details

I. General information

NPI: 1316482201
Provider Name (Legal Business Name): PROVIDENCE PAIN, SPINE & RECOVERY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2016
Last Update Date: 04/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 BERKSHIRE RD
SMITHFIELD NC
27577
US

IV. Provider business mailing address

8311 BRIER CREEK PKWY STE 105-78
RALEIGH NC
27617
US

V. Phone/Fax

Practice location:
  • Phone: 919-596-3400
  • Fax:
Mailing address:
  • Phone: 919-596-3400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number181038
License Number StateNC

VIII. Authorized Official

Name: MELISSA MAY ZECHES
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 919-596-3400