MEDICARE: WV SPINE AND PAIN CLINIC

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	207LP2900X	Pain Medicine (Anesthesiology) Physician	20962	WV
2	208VP0014X	Interventional Pain Medicine Physician	20962	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700079704
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WV SPINE AND PAIN CLINIC

Provider Business Mailing Address
First Line	:	PO BOX 58125
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25358-0125
Country	:	US
Telephone Number	:	304-561-7879
Fax Number	:	304-307-6619

Provider Business Practice Location Address
First Line	:	314 GOFF MOUNTAIN RD
Second Line	:	SUITE 16
City	:	CROSS LANES
State	:	WV
Zip	:	25313-6602
Country	:	US
Telephone Number	:	304-561-7879
Fax Number	:	304-307-6619

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. WEIXING WILLIAM GUO
Credential	:	M.D.
Telephone Number	:	304-561-7879

Provider Enumeration Date	:	08/22/2007
Last Update Date	:	08/22/2007

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Practice Location Address:

314 GOFF MOUNTAIN RD , SUITE 3
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1760446827 — JAMES ALFRED HORN FNP-BC
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25313-6602

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1033213699 — DAVID A BRISCOE P.T.
Practice Location Address:

314 GOFF MOUNTAIN RD , SUITE 13
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1114112042 — DR. DAVID JAMES CORNISH DPM
Practice Location Address:

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1417194499 — TAYLOR S BRAMMER LMT
Practice Location Address:

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Practice Fax:

Directions to “WV SPINE AND PAIN CLINIC ” Practice Location

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