Provider Demographics
NPI:1073605663
Name:MORRISTOWN PAIN CONSULTANTS
Entity Type:Organization
Organization Name:MORRISTOWN PAIN CONSULTANTS
Other - Org Name:BROADWAY NECK AND SPINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:CHAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-444-5059
Mailing Address - Street 1:1124 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-6527
Mailing Address - Country:US
Mailing Address - Phone:865-444-5059
Mailing Address - Fax:865-540-6804
Practice Address - Street 1:1124 N BROADWAY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-6527
Practice Address - Country:US
Practice Address - Phone:865-444-5059
Practice Address - Fax:865-540-6804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN32281207LP2900X
TN207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3378614Medicaid
TN6455330001OtherMEDICARE DME PTAN
TN3848928Medicaid