MEDICARE: INTERVENTIONAL PAIN CONSULTANTS

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	208VP0000X	Pain Medicine Physician
2	208VP0014X	Interventional Pain Medicine Physician

General Provider Information

NPI Number	:	1174241145
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERVENTIONAL PAIN CONSULTANTS

Provider Business Mailing Address
First Line	:	PO BOX 2070
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37320-2070
Country	:	US
Telephone Number	:	423-339-9581
Fax Number	:	423-472-0493

Provider Business Practice Location Address
First Line	:	2550 BUSINESS PARK DR NE
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37311-6503
Country	:	US
Telephone Number	:	423-339-9581
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	KARI WIDDIFIELD
Credential	:
Telephone Number	:	423-339-9581

Provider Enumeration Date	:	08/16/2022
Last Update Date	:	08/30/2023

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