Provider Demographics
NPI:1346408838
Name:CENTER FOR PAIN RELIEF INC.
Entity type:Organization
Organization Name:CENTER FOR PAIN RELIEF INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD, OWNER, PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:DEER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-347-6120
Mailing Address - Street 1:400 COURT ST STE 100
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1652
Mailing Address - Country:US
Mailing Address - Phone:304-347-6120
Mailing Address - Fax:304-347-6126
Practice Address - Street 1:100 PEYTON WAY STE 100
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-8545
Practice Address - Country:US
Practice Address - Phone:304-720-6747
Practice Address - Fax:304-720-6749
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTER FOR PAIN RELIEF INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-30
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV17647208100000X, 2081P2900X, 208VP0014X, 332B00000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0011253000Medicaid
WV9296571OtherMEDICARE OTHER
WV5544650001Medicare NSC