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General NPI Number Information
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NPI Number | 1750680328
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Entity Type | Organization
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Legal Business Name | ROANE COUNTY INTERVENTIONAL PAIN MANAGEMENT LLC
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Dates
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Enumeration Date | 03/22/2011
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Last Update Date | 09/28/2011
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Provider Practice Location Address
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Address Line | 1468 GATEWAY AVE
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City | ROCKWOOD
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State | TN
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Zip | 37854-4143
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Country | US
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Telephone | 865-466-0650
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 476
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City | HARRIMAN
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State | TN
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Zip | 37748-0476
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRACTICE ADM
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Name | MS. MARY MARTELLONI
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Credential |
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Telephone | 865-466-0650
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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