Healthcare Provider Details

I. General information

NPI: 1174241145
Provider Name (Legal Business Name): INTERVENTIONAL PAIN CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 BUSINESS PARK DR NE
CLEVELAND TN
37311-6503
US

IV. Provider business mailing address

PO BOX 2070
CLEVELAND TN
37320-2070
US

V. Phone/Fax

Practice location:
  • Phone: 423-339-9581
  • Fax:
Mailing address:
  • Phone: 423-339-9581
  • Fax: 423-472-0493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KARI WIDDIFIELD
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 423-339-9581