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General NPI Number Information
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NPI Number | 1609356518
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Entity Type | Organization
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Legal Business Name | PAIN MANAGEMENT CENTERS OF SOUTHWEST VIRGINIA
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Dates
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Enumeration Date | 08/20/2018
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Last Update Date | 08/20/2018
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Provider Practice Location Address
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Address Line | 30-31 TOWN CENTER DRIVE
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City | DUBLIN
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State | VA
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Zip | 24084
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Country | US
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Telephone | 540-772-9154
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Fax |
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Provider Business Mailing Address
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Address Line | 2726 ELECTRIC ROAD SUITE 101
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City | ROANOKE
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State | VA
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Zip | 24018
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Country | US
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Telephone | 540-772-9154
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Fax |
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | ROBERT L PRESSLEY
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Credential |
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Telephone | 540-772-9154
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 0101222244
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License Number State | VA
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