Provider Demographics
NPI:1104643972
Name:BRAIN, SPINE AND PAIN INSTITUTE OF VIRGINIA LLC
Entity type:Organization
Organization Name:BRAIN, SPINE AND PAIN INSTITUTE OF VIRGINIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:OCHIENG
Authorized Official - Last Name:MBEO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-721-3460
Mailing Address - Street 1:8280 WILLOW OAKS CORPORATE DR STE 600
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4516
Mailing Address - Country:US
Mailing Address - Phone:443-839-4889
Mailing Address - Fax:
Practice Address - Street 1:603 W BROAD ST STE 200
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3259
Practice Address - Country:US
Practice Address - Phone:443-839-4889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center