Healthcare Provider Details

I. General information

NPI: 1447446570
Provider Name (Legal Business Name): PAIN CONSULTANTS OF WEST TENNESSEE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 12/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 W UNIVERSITY PKWY STE C
JACKSON TN
38305-1667
US

IV. Provider business mailing address

160 W UNIVERSITY PKWY STE C
JACKSON TN
38305-1667
US

V. Phone/Fax

Practice location:
  • Phone: 731-660-5116
  • Fax: 731-660-5119
Mailing address:
  • Phone: 731-660-5116
  • Fax: 731-660-5119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD14614
License Number StateTN

VIII. Authorized Official

Name: DR. FRANK EDWIN JORDAN
Title or Position: OWNER
Credential: M.D.
Phone: 731-660-5116