=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841522620
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RESPONSIBLE PAIN & AESTHETIC MANAGEMENT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2010
-----------------------------------------------------
Last Update Date | 09/10/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 310 GEORGE ST.
-----------------------------------------------------
City | BECKLEY
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-860-1931
-----------------------------------------------------
Fax | 304-860-1933
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 310 GEORGE ST.
-----------------------------------------------------
City | BECKLEY
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-860-1931
-----------------------------------------------------
Fax | 304-860-1933
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN/OWNER
-----------------------------------------------------
Name | MR. JOSE JORGE GORDINHO
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 304-860-1931
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 82326001
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------