Provider Demographics
NPI:1316482201
Name:PROVIDENCE PAIN, SPINE & RECOVERY, PLLC
Entity type:Organization
Organization Name:PROVIDENCE PAIN, SPINE & RECOVERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:MAY
Authorized Official - Last Name:ZECHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-596-3400
Mailing Address - Street 1:8311 BRIER CREEK PKWY
Mailing Address - Street 2:STE 105-78
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617
Mailing Address - Country:US
Mailing Address - Phone:919-596-3400
Mailing Address - Fax:
Practice Address - Street 1:7 BERKSHIRE RD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577
Practice Address - Country:US
Practice Address - Phone:919-596-3400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-30
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC181038207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty