1982146361 NPI number — PAIN MANAGEMENT OF MIDDLE TENNESSEE PLLC

Table of content: (NPI 1982146361)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982146361 NPI number — PAIN MANAGEMENT OF MIDDLE TENNESSEE PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAIN MANAGEMENT OF MIDDLE TENNESSEE PLLC
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:
6
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:
1982146361
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/03/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 29TH AVE N
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37203-1401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-327-4340
Provider Business Mailing Address Fax Number:
615-327-7940

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
330 23RD AVE N
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37203-1534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-620-1650
Provider Business Practice Location Address Fax Number:
615-620-1654
Provider Enumeration Date:
11/16/2016

Additional Information

Authorized Official

Authorized Official Last Name:
FORREST
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
615-327-4304

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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