Healthcare Provider Details

I. General information

NPI: 1710380704
Provider Name (Legal Business Name): PAIN MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2014
Last Update Date: 11/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 BRADLEY ST STE. A
CONCORD NC
28025-2979
US

IV. Provider business mailing address

PO BOX 681789
FRANKLIN TN
37068-1789
US

V. Phone/Fax

Practice location:
  • Phone: 704-721-0535
  • Fax:
Mailing address:
  • Phone: 615-503-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. CARROLL E COMBS JR.
Title or Position: CORPORATE COUNSEL
Credential:
Phone: 615-435-0553