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General NPI Number Information
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NPI Number | 1346558400
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Entity Type | Organization
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Legal Business Name | CONSULTANTS IN PAIN MEDICINE, LLC
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Dates
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Enumeration Date | 09/22/2010
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Last Update Date | 04/18/2011
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Provider Practice Location Address
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Address Line | 2452 MEMORIAL DR
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City | WAYCROSS
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State | GA
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Zip | 31503-6336
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Country | US
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Telephone | 912-283-6877
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Fax | 912-283-6879
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Provider Business Mailing Address
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Address Line | 3221 GLYNN AVE
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City | BRUNSWICK
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State | GA
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Zip | 31520-4851
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Country | US
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Telephone | 912-466-9111
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Fax | 912-466-0366
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Authorized Official
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Title or Position | OWNER
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Name | DR. THOMAS E RUNYAN
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Credential | M.D.
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Telephone | 912-466-9111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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