Provider Demographics
NPI:1144381930
Name:PAIN CLINIC ASSOCIATES PLLC
Entity Type:Organization
Organization Name:PAIN CLINIC ASSOCIATES PLLC
Other - Org Name:THE PAIN CLINIC PHYSICAL THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:BOARD MEMBER CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOACIR
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHNAPP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-747-0040
Mailing Address - Street 1:PO BOX 931320
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-1320
Mailing Address - Country:US
Mailing Address - Phone:901-747-0040
Mailing Address - Fax:901-747-4340
Practice Address - Street 1:55 HUMPHREYS CENTER DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2366
Practice Address - Country:US
Practice Address - Phone:901-747-0040
Practice Address - Fax:901-747-4340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DB4597OtherRAILROAD MEDICARE
TN3387516Medicaid
DB4597OtherRAILROAD MEDICARE