| NPI | 1740549302 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDY JACKSON Chief Information Officer 757-873-1554 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine |
| Additional Taxonomies | 208VP0000X Pain Medicine Pain Medicine |
| 208VP0014X Pain Medicine Interventional Pain Medicine | |
| Enumeration Date | 2012-05-16 |
| Last Update Date | 2025-05-14 |