Provider Demographics
NPI:1043353808
Name:TENNESSEE PAIN CONSULTANTS PC
Entity Type:Organization
Organization Name:TENNESSEE PAIN CONSULTANTS PC
Other - Org Name:SPINAL DECOMPRESSION AND REHABILITATION SYSTEMS PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:SILCOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-587-8314
Mailing Address - Street 1:PO BOX 51410
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37950-1410
Mailing Address - Country:US
Mailing Address - Phone:423-587-8314
Mailing Address - Fax:423-585-0015
Practice Address - Street 1:230 BOWMAN ST
Practice Address - Street 2:SUITE C
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-3871
Practice Address - Country:US
Practice Address - Phone:423-587-8314
Practice Address - Fax:423-585-0015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
TNDO0000000682207Q00000X
TN71290034207R00000X
TN5529207T00000X
TNNP11594363LF0000X
TNAPN12848363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5873610001Medicare NSC
TN3736764Medicare PIN