Healthcare Provider Details

I. General information

NPI: 1245263292
Provider Name (Legal Business Name): CHATTANOOGA PAIN MANAGEMENT CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 EXECUTIVE DR
HIXSON TN
37343-3995
US

IV. Provider business mailing address

1016 EXECUTIVE DR
HIXSON TN
37343-3995
US

V. Phone/Fax

Practice location:
  • Phone: 615-376-7550
  • Fax: 615-329-6290
Mailing address:
  • Phone: 615-376-7550
  • Fax: 615-329-6290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number183
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number183
License Number StateTN

VIII. Authorized Official

Name: KRISTEN OCONNOR
Title or Position: OFFICER/AUTHORIZED OFFICIAL
Credential:
Phone: 615-376-7315