Healthcare Provider Details

I. General information

NPI: 1275607129
Provider Name (Legal Business Name): CONSULTANTS IN PAIN MANAGEMENT, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 STEIN DR
CHATTANOOGA TN
37421-1690
US

IV. Provider business mailing address

2000 STEIN DR
CHATTANOOGA TN
37421-1690
US

V. Phone/Fax

Practice location:
  • Phone: 423-648-8480
  • Fax: 423-648-8481
Mailing address:
  • Phone: 423-648-8480
  • Fax: 423-648-8481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ANDREW BAYSORE
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 423-648-8480