1962655696 NPI number — PAIN MEDICINE ASSOCIATES, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962655696 NPI number — PAIN MEDICINE ASSOCIATES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAIN MEDICINE ASSOCIATES, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962655696
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 MED TECH PKWY
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
JOHNSON CITY
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37604-4007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-232-6120
Provider Business Mailing Address Fax Number:
423-232-6125

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 MED TECH PKWY
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37604-4007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-232-6120
Provider Business Practice Location Address Fax Number:
423-232-6125
Provider Enumeration Date:
10/28/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BAYS
Authorized Official First Name:
TRACY
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
423-232-6120

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  1084 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3715213 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 134016XX . This is a "PREFERRED CARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: CG3754 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 373941500 . This is a "DEPT OF LABOR" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 146990 . This is a "ANTHEM VA - BRISTOL" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 146991 . This is a "ANTHEM VA - KPT" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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