Organization
ADVANCED INTERVENTIONAL PAIN MANAGEMENT, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JOHNETTE CAROL SHULTZ (CFO, PRACTICE ADMINISTRATOR)
(336) 714-6406
Entity
Organization
Contact information
Practice address
160 KIMEL FOREST DR, SUITE100, WINSTON SALEM, NC 27103-6074
(336) 714-6400
(336) 714-6402
Mailing address
160 KIMEL FOREST DR, SUITE 100, WINSTON SALEM, NC 27103-6074
(336) 714-6400
(336) 714-6402
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016HC
BLUE CROSS & BLUE SHIELD
NC
01
—
607132000
DEPT. OF LABOR
NC
01
—
7679698
AETNA
NC
05
—
89016HC
—
NC
01
—
I915
PARTNERS NATIONAL HEALTH
NC
Enumeration date
04/19/2006
Last updated
01/06/2010
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