MEDICARE: TENNESSEE RIVER PAIN MANAGEMENT CLINIC

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	363LA2200X	Adult Health Nurse Practitioner	13057	TN

General Provider Information

NPI Number	:	1447578018
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TENNESSEE RIVER PAIN MANAGEMENT CLINIC

Provider Business Mailing Address
First Line	:	275A EUREKA ST
Second Line	:
City	:	SAVANNAH
State	:	TN
Zip	:	38372-3033
Country	:	US
Telephone Number	:	731-925-7246
Fax Number	:

Provider Business Practice Location Address
First Line	:	275A EUREKA ST
Second Line	:
City	:	SAVANNAH
State	:	TN
Zip	:	38372-3033
Country	:	US
Telephone Number	:	731-925-7246
Fax Number	:	731-925-7991

Authorized Official
Title or Position	:	NP
Name	:	MS. TERESA DIANE DAILEY
Credential	:	NP, MSN
Telephone Number	:	731-925-7246

Provider Enumeration Date	:	05/06/2010
Last Update Date	:	08/04/2010

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