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General NPI Number Information
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NPI Number | 1215272547
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Entity Type | Organization
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Legal Business Name | COOKEVILLE CENTER FOR PAIN MANAGEMENT PC
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Dates
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Enumeration Date | 11/27/2012
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Last Update Date | 02/20/2013
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Provider Practice Location Address
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Address Line | 580 S JEFFERSON AVE
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City | COOKEVILLE
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State | TN
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Zip | 38501-4672
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Country | US
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Telephone | 931-526-7104
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Fax | 931-526-7105
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Provider Business Mailing Address
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Address Line | PO BOX 4129
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City | COOKEVILLE
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State | TN
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Zip | 38502-4129
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Country | US
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Telephone | 931-526-7104
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Fax | 931-526-7105
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | CHARLOTTE D MARKS
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Credential |
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Telephone | 931-526-7104
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State | TN
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