Healthcare Provider Details

I. General information

NPI: 1346534286
Provider Name (Legal Business Name): AMBULATORY CARE PAIN SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2011
Last Update Date: 06/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2497 S ROANE ST
HARRIMAN TN
37748-8670
US

IV. Provider business mailing address

PO BOX 368
WARTBURG TN
37887-0368
US

V. Phone/Fax

Practice location:
  • Phone: 423-346-5566
  • Fax: 423-346-5631
Mailing address:
  • Phone: 423-346-5566
  • Fax: 423-346-5631

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: SANJAY P THAKUR
Title or Position: PHYSICIAN/OWNER
Credential: M.D.
Phone: 423-346-5566