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General NPI Number Information
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NPI Number | 1124087549
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Entity Type | Organization
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Legal Business Name | PAIN MANAGEMENT CENTER
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Dates
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Enumeration Date | 03/23/2006
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Last Update Date | 11/06/2007
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Provider Practice Location Address
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Address Line | 600 18TH ST
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City | PARKERSBURG
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State | WV
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Zip | 26101-3231
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Country | US
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Telephone | 304-422-4040
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Fax | 304-424-4022
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Provider Business Mailing Address
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Address Line | 3211 DUDLEY AVE
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City | PARKERSBURG
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State | WV
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Zip | 26104-1813
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Country | US
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Telephone | 304-422-3904
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Fax | 304-422-3924
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Authorized Official
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Title or Position | TREASURER
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Name | JEFFREY R MATHENY
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Credential |
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Telephone | 304-422-3904
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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