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General NPI Number Information
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NPI Number | 1518998764
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Entity Type | Organization
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Legal Business Name | TENNESSEE PAIN SURGERY CENTER, LLC
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 11/29/2011
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Provider Practice Location Address
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Address Line | 5811 CROSSINGS BLVD
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City | ANTIOCH
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State | TN
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Zip | 37013-3130
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Country | US
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Telephone | 615-941-4820
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Fax | 615-941-4989
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Provider Business Mailing Address
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Address Line | 5811 CROSSINGS BLVD
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City | ANTIOCH
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State | TN
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Zip | 37013-3130
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Country | US
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Telephone | 615-941-4820
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Fax | 615-941-4989
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Authorized Official
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Title or Position | BUSINESS OFFICE MANAGER
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Name | MR. DEREK OLIVER
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Credential |
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Telephone | 615-941-8501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 154
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License Number State | TN
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