Basic Information
| Provider Information | |||||||||
| NPI: | 1124406350 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WEST VIRGINIA PAIN INSTITUTE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5357 | ||||||||
| Address2: | |||||||||
| City: | BECKLEY | ||||||||
| State: | WV | ||||||||
| PostalCode: | 258017504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042543131 | ||||||||
| FaxNumber: | 3042543201 | ||||||||
| Practice Location | |||||||||
| Address1: | 1717 HARPER RD | ||||||||
| Address2: | SECOND FLOOR, SUITE D | ||||||||
| City: | BECKLEY | ||||||||
| State: | WV | ||||||||
| PostalCode: | 258013373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042543131 | ||||||||
| FaxNumber: | 3042543201 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2015 | ||||||||
| LastUpdateDate: | 05/07/2015 | ||||||||
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| AuthorizedOfficialLastName: | THYMIUS | ||||||||
| AuthorizedOfficialFirstName: | ANDREW | ||||||||
| AuthorizedOfficialMiddleName: | C. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3042543131 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0014X | 1729 | WV | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
No ID Information.