1124087549

Everything you always wanted to know about PAIN MANAGEMENT CENTER MATHENY R JEFFREY but were afraid to ask.

PAIN MANAGEMENT CENTER MATHENY R JEFFREY

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Organization Name Authorized Official Last Name Authorized Official Middle Name Authorized Official First Name
PAIN MANAGEMENT CENTER MATHENY R JEFFREY
Gender:
none
Enumeration date:
2006-03-23
Last update date:
2007-11-06
Current as of:
Is sole proprietor?:
No
Is organization subpart?:
No
In PECOS?:
No

Identifiers

identifier description issuer state
0830220 Medicaid none OH
0007055000 Medicaid none WV

Taxonomies

Taxonomy State License Number Primary?
208VP0000X Pain Medicine none none N
208VP0014X Interventional Pain Medicine none none Y

Phone Numbers

Type Number
Mailing Address Telephone Number 3044223904
Authorized Official Telephone Number 3044223904
Mailing Address Fax Number 3044223924
Practice Location Address Telephone Number 3044224040
Practice Location Address Fax Number 3044244022

Addresses

Type Address City State Postal Country
Mailing Address 3211 DUDLEY AVE PARKERSBURG WV 26104 WV
Practice Location Address 600 18TH ST PARKERSBURG WV 26101 WV

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