Healthcare Provider Details

I. General information

NPI: 1386662013
Provider Name (Legal Business Name): THE CENTER FOR PAIN RELIEF TRI STATE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 12/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PEYTON WAY STE 200 CPRTS ADMINISTRATIVE OFFICE
CHARLESTON WV
25309-8545
US

IV. Provider business mailing address

100 PEYTON WAY STE 200 THE CENTER FOR PAIN RELIEF TRI STATE PLLC
CHARLESTON WV
25309-8545
US

V. Phone/Fax

Practice location:
  • Phone: 904-436-0153
  • Fax: 904-494-6467
Mailing address:
  • Phone: 904-436-0153
  • Fax: 904-494-6467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WX0800X
TaxonomyOrthopedic Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 8
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number18714
License Number StateWV

VIII. Authorized Official

Name: DAVID L. CARAWAY
Title or Position: MANAGING MEMBER
Credential: M.D.
Phone: 304-881-2102