Provider Demographics
NPI:1528063542
Name:CENTER FOR PAIN MANAGEMENT PLLC
Entity type:Organization
Organization Name:CENTER FOR PAIN MANAGEMENT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:KNAB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-442-1200
Mailing Address - Street 1:1602 PHYSICIANS DR STE 103
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7350
Mailing Address - Country:US
Mailing Address - Phone:910-442-1200
Mailing Address - Fax:910-442-1296
Practice Address - Street 1:1602 PHYSICIANS DR STE 103
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7350
Practice Address - Country:US
Practice Address - Phone:910-442-1200
Practice Address - Fax:910-442-1297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1234208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2324887Medicare PIN