Healthcare Provider Details

I. General information

NPI: 1699775536
Provider Name (Legal Business Name): PAIN MANAGEMENT ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2139 AUBURN AVE
CINCINNATI OH
45219-2906
US

IV. Provider business mailing address

265 BROOKVIEW CENTRE WAY STE 203
KNOXVILLE TN
37919-4053
US

V. Phone/Fax

Practice location:
  • Phone: 513-585-2000
  • Fax: 513-672-4479
Mailing address:
  • Phone: 865-985-7114
  • Fax: 865-692-5867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: STACEY MICHELLE WILSON
Title or Position: DIRECTOR
Credential:
Phone: 865-985-7114