Provider Demographics
NPI:1346562048
Name:PAIN MANAGEMENT GROUP, P.C.
Entity Type:Organization
Organization Name:PAIN MANAGEMENT GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-941-8501
Mailing Address - Street 1:5801 CROSSINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-3130
Mailing Address - Country:US
Mailing Address - Phone:615-941-8501
Mailing Address - Fax:615-941-8102
Practice Address - Street 1:40 W CALDWELL ST
Practice Address - Street 2:SUITE 200
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-2910
Practice Address - Country:US
Practice Address - Phone:615-553-5640
Practice Address - Fax:615-553-5644
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAIN MANAGEMENT GROUP, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-22
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3710456Medicare PIN