Healthcare Provider Details

I. General information

NPI: 1639509664
Provider Name (Legal Business Name): PAIN MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2013
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 COOL SPRINGS BLVD STE. 550
FRANKLIN TN
37067-2702
US

IV. Provider business mailing address

PO BOX 681789
FRANKLIN TN
37068-1789
US

V. Phone/Fax

Practice location:
  • Phone: 615-503-9000
  • Fax:
Mailing address:
  • Phone: 615-503-9000
  • Fax: 615-435-0549

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
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CARROLL E COMBS JR.
Title or Position: CORPORATE COUNSEL
Credential:
Phone: 615-435-0553