Healthcare Provider Details

I. General information

NPI: 1497414437
Provider Name (Legal Business Name): PERIMETER PAIN AND PRIMARY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2021
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

879 W JACKSON ST
COOKEVILLE TN
38501-5901
US

IV. Provider business mailing address

879 W JACKSON ST
COOKEVILLE TN
38501-5901
US

V. Phone/Fax

Practice location:
  • Phone: 931-486-3345
  • Fax: 615-535-5978
Mailing address:
  • Phone: 931-400-7246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TIMOTHY BUNKER
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 931-486-3345