Provider Demographics
NPI:1003233743
Name:OMEGA PAIN MANAGEMENT, PC
Entity Type:Organization
Organization Name:OMEGA PAIN MANAGEMENT, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:SMELYANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-523-4576
Mailing Address - Street 1:PO BOX 32965
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37930-2965
Mailing Address - Country:US
Mailing Address - Phone:865-337-5137
Mailing Address - Fax:865-312-8350
Practice Address - Street 1:6348 LONAS SPRING DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2719
Practice Address - Country:US
Practice Address - Phone:865-337-5137
Practice Address - Fax:888-839-6922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-19
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ007280Medicaid
TN103G705993Medicare PIN