Healthcare Provider Details

I. General information

NPI: 1073049102
Provider Name (Legal Business Name): PAIN INSTITUTE OF NASHVILLE, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2017
Last Update Date: 12/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1849 MADISON ST STE F
CLARKSVILLE TN
37043-4903
US

IV. Provider business mailing address

PO BOX 330175
NASHVILLE TN
37203-7501
US

V. Phone/Fax

Practice location:
  • Phone: 931-802-6824
  • Fax:
Mailing address:
  • Phone: 931-802-6824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number11765
License Number StateTN

VIII. Authorized Official

Name: RON WOOD
Title or Position: BILLING MANAGER
Credential:
Phone: 615-478-6371