MEDICARE: PAIN SERVICES, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1154451946
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAIN SERVICES, PC

Provider Business Mailing Address
First Line	:	6005 PARK AVE STE 802
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38119-5218
Country	:	US
Telephone Number	:	901-763-0037
Fax Number	:	901-763-0065

Provider Business Practice Location Address
First Line	:	6005 PARK AVE STE 802
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38119-5218
Country	:	US
Telephone Number	:	901-763-0037
Fax Number	:	901-763-0065

Authorized Official
Title or Position	:	CEO
Name	:	DR. AUTRY J PARKER
Credential	:	MD
Telephone Number	:	901-763-0037

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	08/22/2020

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