Healthcare Provider Details

I. General information

NPI: 1407192735
Provider Name (Legal Business Name): VIRGINIA INTERVENTIONAL PAIN & SPINE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2012
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 ELECTRIC RD STE 307
ROANOKE VA
24018-4568
US

IV. Provider business mailing address

PO BOX 8310
ROANOKE VA
24014-0310
US

V. Phone/Fax

Practice location:
  • Phone: 540-777-0090
  • Fax:
Mailing address:
  • Phone: 540-777-0090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. CHHEANY UNG
Title or Position: PRESIDENT
Credential: MD
Phone: 540-777-0090