Healthcare Provider Details

I. General information

NPI: 1982930350
Provider Name (Legal Business Name): CENTER FOR PAIN MANAGEMENT, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2009
Last Update Date: 12/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 MOUSE CREEK RD NW
CLEVELAND TN
37312-4840
US

IV. Provider business mailing address

65 MOUSE CREEK RD NW
CLEVELAND TN
37312-4840
US

V. Phone/Fax

Practice location:
  • Phone: 423-790-5671
  • Fax: 423-790-5677
Mailing address:
  • Phone: 423-790-5671
  • Fax: 423-790-5677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: NEAL H. FRAUWIRTH
Title or Position: OWNER
Credential: MD
Phone: 423-790-5671