Basic Information
Provider Information | |||||||||
NPI: | 1649200098 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | NC PAIN MANAGEMENT SERVICES PA | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 609 | ||||||||
Address2: |   | ||||||||
City: | OAK RIDGE | ||||||||
State: | NC | ||||||||
PostalCode: | 273100609 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3365387180 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1236 HUFFMAN MILL RD | ||||||||
Address2: | SUITE 2000 | ||||||||
City: | BURLINGTON | ||||||||
State: | NC | ||||||||
PostalCode: | 272158700 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3365387180 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/03/2006 | ||||||||
LastUpdateDate: | 06/05/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | NAVEIRA | ||||||||
AuthorizedOfficialFirstName: | FRANCISCO | ||||||||
AuthorizedOfficialMiddleName: | ARTURO | ||||||||
AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
AuthorizedOfficialTelephone: | 3365387180 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MD | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0014X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
ID Information
ID | Type | State | Issuer | Description | 5903634 | 05 | NC |   | MEDICAID | DE6641 | 01 |   | RAILROAD MEDICARE | OTHER |