Provider Demographics
NPI:1003120882
Name:TENNESSEE PAIN PROFESSIONALS
Entity Type:Organization
Organization Name:TENNESSEE PAIN PROFESSIONALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BONI
Authorized Official - Middle Name:EILEEN
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-318-2130
Mailing Address - Street 1:PO BOX 1749
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37849-1749
Mailing Address - Country:US
Mailing Address - Phone:865-247-5221
Mailing Address - Fax:866-929-1978
Practice Address - Street 1:2507 MINERAL SPRINGS AVE
Practice Address - Street 2:SUITE A
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-1549
Practice Address - Country:US
Practice Address - Phone:865-247-5221
Practice Address - Fax:866-929-1978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain