Provider Demographics
NPI:1386973253
Name:WINKE ORTHOPEDIC PAIN MANAGEMENT CENTER
Entity type:Organization
Organization Name:WINKE ORTHOPEDIC PAIN MANAGEMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:WINKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-216-4030
Mailing Address - Street 1:808 EDEN WAY N STE 102
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-0745
Mailing Address - Country:US
Mailing Address - Phone:757-216-4030
Mailing Address - Fax:757-216-4029
Practice Address - Street 1:808 EDEN WAY N STE 102
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-0745
Practice Address - Country:US
Practice Address - Phone:757-216-4030
Practice Address - Fax:757-216-4029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-23
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101054160208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7569020001Medicare NSC