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General NPI Number Information
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NPI Number | 1982669339
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Entity Type | Organization
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Legal Business Name | ADVANCED INTERVENTIONAL PAIN MANAGEMENT, PA
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Dates
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Enumeration Date | 04/19/2006
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Last Update Date | 01/06/2010
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Provider Practice Location Address
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Address Line | 160 KIMEL FOREST DR SUITE100
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City | WINSTON SALEM
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State | NC
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Zip | 27103-6074
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Country | US
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Telephone | 336-714-6400
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Fax | 336-714-6402
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Provider Business Mailing Address
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Address Line | 160 KIMEL FOREST DR SUITE 100
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City | WINSTON SALEM
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State | NC
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Zip | 27103-6074
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Country | US
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Telephone | 336-714-6400
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Fax | 336-714-6402
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Authorized Official
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Title or Position | CFO, PRACTICE ADMINISTRATOR
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Name | MRS. JOHNETTE CAROL SHULTZ
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Credential |
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Telephone | 336-714-6406
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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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