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General NPI Number Information
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NPI Number | 1386662013
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Entity Type | Organization
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Legal Business Name | THE CENTER FOR PAIN RELIEF TRI STATE PLLC
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 12/03/2014
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Provider Practice Location Address
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Address Line | 100 PEYTON WAY STE 200 CPRTS ADMINISTRATIVE OFFICE
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City | CHARLESTON
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State | WV
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Zip | 25309-8545
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Country | US
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Telephone | 904-436-0153
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Fax | 904-494-6467
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Provider Business Mailing Address
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Address Line | 100 PEYTON WAY STE 200 THE CENTER FOR PAIN RELIEF TRI STATE PLLC
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City | CHARLESTON
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State | WV
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Zip | 25309-8545
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Country | US
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Telephone | 904-436-0153
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Fax | 904-494-6467
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DAVID L. CARAWAY
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Credential | M.D.
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Telephone | 304-881-2102
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0000X
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Taxonomy Name | Pain Management Registered Nurse
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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 | 163WX0800X
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Taxonomy Name | Orthopedic Registered Nurse
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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Taxonomy #5
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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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Taxonomy #6
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 18714
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License Number State | WV
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