1699072918 NPI number — PAIN RELIEF TREATMENT CENTER, LLC

Table of content: (NPI 1699072918)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699072918 NPI number — PAIN RELIEF TREATMENT CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAIN RELIEF TREATMENT CENTER, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699072918
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 544
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HERNDON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20172-0544
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-856-2553
Provider Business Mailing Address Fax Number:
703-404-2763

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3022 JAVIER RD
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
FAIRFAX
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22031-4645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-856-2553
Provider Business Practice Location Address Fax Number:
703-404-2763
Provider Enumeration Date:
02/23/2011

Additional Information

Authorized Official

Authorized Official Last Name:
LOUIE
Authorized Official First Name:
CYBIL
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
703-856-2553

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  0019009158 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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