Provider Demographics
NPI:1285037754
Name:REGIONAL PAIN CENTER, LLC
Entity Type:Organization
Organization Name:REGIONAL PAIN CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:HOLLIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:901-800-1336
Mailing Address - Street 1:PO BOX 908
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38088-0908
Mailing Address - Country:US
Mailing Address - Phone:901-800-1336
Mailing Address - Fax:901-379-8955
Practice Address - Street 1:6605 STAGE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134-2808
Practice Address - Country:US
Practice Address - Phone:901-800-1336
Practice Address - Fax:901-379-8955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC1282111N00000X
TNDC1082111N00000X
TNMD31712207Q00000X
TNPT8229225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty