Provider Demographics
NPI:1548768328
Name:CHILHOWEE MEDICAL, INC.
Entity Type:Organization
Organization Name:CHILHOWEE MEDICAL, INC.
Other - Org Name:CHILHOWEE MEDICAL, INC. DBA CHILHOWEE PAIN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE CONSULTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAWAYNE
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:CANTRELL
Authorized Official - Suffix:
Authorized Official - Credentials:AUTHORIZED SIGNATURE
Authorized Official - Phone:888-352-5559
Mailing Address - Street 1:253 REYNOLDS ROAD
Mailing Address - Street 2:CHILHOWEE MEDICAL, INC. IN CARE OF DAWAYNE CANTRELL
Mailing Address - City:KEAVY
Mailing Address - State:KY
Mailing Address - Zip Code:40737
Mailing Address - Country:US
Mailing Address - Phone:888-352-5559
Mailing Address - Fax:606-363-0789
Practice Address - Street 1:2012 CHILHOWEE MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804
Practice Address - Country:US
Practice Address - Phone:865-981-8838
Practice Address - Fax:865-380-8868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-26
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1136163WP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0000XNursing Service ProvidersRegistered NursePain ManagementGroup - Single Specialty