Provider Demographics
NPI:1083194237
Name:SPECTRUM PAIN CLINICS INC.
Entity Type:Organization
Organization Name:SPECTRUM PAIN CLINICS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:J
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-507-0062
Mailing Address - Street 1:311 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:TN
Mailing Address - Zip Code:38261-3723
Mailing Address - Country:US
Mailing Address - Phone:731-507-0062
Mailing Address - Fax:731-507-0068
Practice Address - Street 1:23 SANDSTONE CIR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2073
Practice Address - Country:US
Practice Address - Phone:731-265-6946
Practice Address - Fax:731-265-6947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty