Provider Demographics
NPI:1477318871
Name:INTERVENTIONAL PAIN CONSULTANTS
Entity Type:Organization
Organization Name:INTERVENTIONAL PAIN CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KARI
Authorized Official - Middle Name:
Authorized Official - Last Name:WIDDIFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-339-9581
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:423-339-9581
Mailing Address - Fax:
Practice Address - Street 1:101 DONNER DR
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-7745
Practice Address - Country:US
Practice Address - Phone:865-685-0941
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies