Provider Demographics
NPI:1245537786
Name:PREFERRED PAIN MANAGEMENT, P.A.
Entity type:Organization
Organization Name:PREFERRED PAIN MANAGEMENT, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SPIVEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-760-0706
Mailing Address - Street 1:245 CHARLOIS BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1507
Mailing Address - Country:US
Mailing Address - Phone:336-760-0706
Mailing Address - Fax:
Practice Address - Street 1:851 OLD WINSTON RD
Practice Address - Street 2:SUITE 105
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-8780
Practice Address - Country:US
Practice Address - Phone:336-760-0706
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-18
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty