Provider Demographics
NPI:1215198643
Name:PAIN CLINIC
Entity Type:Organization
Organization Name:PAIN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-903-6796
Mailing Address - Street 1:765 TASSO LN NE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-4559
Mailing Address - Country:US
Mailing Address - Phone:423-903-6796
Mailing Address - Fax:
Practice Address - Street 1:294 CHUBBY DR
Practice Address - Street 2:SUITE 2
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-1358
Practice Address - Country:US
Practice Address - Phone:662-327-6820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11125207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty