Provider Demographics
NPI:1336640507
Name:ELITE PAIN CONSULTANTS, PLLC
Entity Type:Organization
Organization Name:ELITE PAIN CONSULTANTS, PLLC
Other - Org Name:ELITE PAIN CONSULTANTS OF KNOXVILLE
Other - Org Type:Other Name
Authorized Official - Title/Position:REVENUE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CASSY
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLEDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-476-5774
Mailing Address - Street 1:PO BOX 2070
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37320-2070
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11416 GRIGSBY CHAPEL RD STE 104
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-1649
Practice Address - Country:US
Practice Address - Phone:865-218-2100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELITE PAIN CONSULTANTS, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-23
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
7741470002OtherMEDICARE NSC