Healthcare Provider Details

I. General information

NPI: 1750872032
Provider Name (Legal Business Name): VIRGINIA INTERVENTIONAL PAIN & SPINE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2018
Last Update Date: 05/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 ELECTRIC RD STE 307
ROANOKE VA
24018-4568
US

IV. Provider business mailing address

3800 ELECTRIC RD STE 307
ROANOKE VA
24018-4568
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: CHHEANY WALTER UNG
Title or Position: CEO
Credential:
Phone: 540-777-0090