1508487083 NPI number — CENTER FOR PAIN MANAGEMENT, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508487083 NPI number — CENTER FOR PAIN MANAGEMENT, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR PAIN MANAGEMENT, 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:
1508487083
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4960 SW 72ND AVE STE 405
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33155-5506
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-458-9222
Provider Business Mailing Address Fax Number:
540-918-7202

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1741 WILLIAMSPORT PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARTINSBURG
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25404-4341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-596-2378
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/06/2020

Additional Information

Authorized Official

Authorized Official Last Name:
FINKLE
Authorized Official First Name:
NICOLE
Authorized Official Middle Name:
Authorized Official Title or Position:
RCM SR. DIRECTOR
Authorized Official Telephone Number:
719-243-9490

Provider Taxonomy Codes

  • Taxonomy code: 208VP0014X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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