Healthcare Provider Details

I. General information

NPI: 1588429971
Provider Name (Legal Business Name): INTERVENTIONAL PAIN CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2024
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11416 GRIGSBY CHAPEL RD STE 104
KNOXVILLE TN
37934-1649
US

IV. Provider business mailing address

PO BOX 2070
CLEVELAND TN
37320-2070
US

V. Phone/Fax

Practice location:
  • Phone: 865-218-2100
  • Fax:
Mailing address:
  • Phone: 423-339-9581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: KARI WIDDIFIELD
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 423-339-9581