MEDICARE: VIRGINIA INTERVENTIONAL PAIN SPECIALISTS, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	0101040954	VA

General Provider Information

NPI Number	:	1184662769
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIRGINIA INTERVENTIONAL PAIN SPECIALISTS, PC

Provider Business Mailing Address
First Line	:	PO BOX 1269
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23113-8269
Country	:	US
Telephone Number	:	804-282-6160
Fax Number	:	804-282-3120

Provider Business Practice Location Address
First Line	:	7603 FOREST AVE
Second Line	:	COURTYARD BUILDING, HENRICO DRS. HOSPITAL
City	:	RICHMOND
State	:	VA
Zip	:	23229-4944
Country	:	US
Telephone Number	:	804-282-6160
Fax Number	:	804-282-3120

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DANIEL C MARTIN
Credential	:	M.D.
Telephone Number	:	804-282-6160

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	08/22/2020

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