Healthcare Provider Details

I. General information

NPI: 1912952557
Provider Name (Legal Business Name): THE PAIN CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 08/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 COLLIERS WAY STE 510
WEIRTON WV
26062-5054
US

IV. Provider business mailing address

109 MOUNT WOOD RD
WHEELING WV
26003-2632
US

V. Phone/Fax

Practice location:
  • Phone: 304-797-6595
  • Fax: 304-797-6052
Mailing address:
  • Phone: 304-797-6595
  • Fax: 304-797-6052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: JORGE ROIG
Title or Position: AUTH REP
Credential: M.D.
Phone: 304-979-6595