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General NPI Number Information
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NPI Number | 1003109646
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL PAIN MANAGEMENT, LLC
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Dates
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Enumeration Date | 05/16/2011
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Last Update Date | 05/16/2011
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Provider Practice Location Address
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Address Line | 301 KEITH ST SW SUITE 204
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City | CLEVELAND
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State | TN
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Zip | 37311-5808
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Country | US
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Telephone | 423-790-7500
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Fax | 423-790-5299
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Provider Business Mailing Address
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Address Line | PO BOX 4350
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City | CLEVELAND
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State | TN
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Zip | 37320-4350
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Country | US
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Telephone | 423-790-7500
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Fax | 423-790-5299
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Authorized Official
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Title or Position | OWNER
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Name | DAVID S. COFER
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Credential | NP
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Telephone | 423-790-7500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 13528
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License Number State | TN
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