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General NPI Number Information
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NPI Number | 1568821221
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Entity Type | Organization
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Legal Business Name | VIRGINIA INNOVATIVE PAIN AND SPINE
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Dates
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Enumeration Date | 02/23/2016
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Last Update Date | 02/23/2016
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Provider Practice Location Address
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Address Line | 2532 MILL RD
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City | POWHATAN
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State | VA
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Zip | 23139-5203
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Country | US
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Telephone | 804-335-0802
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Fax | 804-335-0802
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Provider Business Mailing Address
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Address Line | 2532 MILL RD
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City | POWHATAN
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State | VA
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Zip | 23139-5203
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | GENEAYE WAKEFIELD
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Credential |
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Telephone | 804-661-8616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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