Organization
BACK PAIN INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. VALERIE IRVIN (MANAGER)
(804) 226-8923
Entity
Organization
Contact information
Practice address
3333 S CRATER RD, PETERSBURG, VA 23805-9276
(804) 733-6870
(804) 226-9496
Mailing address
PO BOX 3466, PETERSBURG, VA 23805-3466
(804) 226-8923
(804) 226-9496
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
249778
ANTHEM
VA
01
—
608600
SOUTHERN HEALTH
VA
01
—
71574
CARNET
VA
Enumeration date
04/04/2007
Last updated
02/27/2008
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