Provider Demographics
NPI:1346534286
Name:AMBULATORY CARE PAIN SPECIALISTS
Entity Type:Organization
Organization Name:AMBULATORY CARE PAIN SPECIALISTS
Other - Org Name:AMBULATORY CARE PAIN SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:P
Authorized Official - Last Name:THAKUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-346-5566
Mailing Address - Street 1:PO BOX 368
Mailing Address - Street 2:
Mailing Address - City:WARTBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37887-0368
Mailing Address - Country:US
Mailing Address - Phone:423-346-5566
Mailing Address - Fax:423-346-5631
Practice Address - Street 1:2497 S ROANE ST
Practice Address - Street 2:
Practice Address - City:HARRIMAN
Practice Address - State:TN
Practice Address - Zip Code:37748-8670
Practice Address - Country:US
Practice Address - Phone:423-346-5566
Practice Address - Fax:423-346-5631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-08
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty