Healthcare Provider Details

I. General information

NPI: 1265459192
Provider Name (Legal Business Name): WEST TENNESSEE PAIN SPECIALISTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 10/23/2020
Certification Date: 10/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 STONEBRIDGE BLVD
JACKSON TN
38305-2042
US

IV. Provider business mailing address

PO BOX 10667
JACKSON TN
38308-0111
US

V. Phone/Fax

Practice location:
  • Phone: 731-660-2056
  • Fax: 731-661-9092
Mailing address:
  • Phone: 731-660-2056
  • Fax: 731-661-9092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number0000022099
License Number StateTN

VIII. Authorized Official

Name: DR. ROY A. SCHMIDT
Title or Position: OWNER/MD
Credential: M.D.
Phone: 731-660-2056