Provider Demographics
NPI:1619212453
Name:STEPHEN V DRESKIN MD PC
Entity Type:Organization
Organization Name:STEPHEN V DRESKIN MD PC
Other - Org Name:TENNESSEE VALLEY PAIN MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:S
Authorized Official - Last Name:GENTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-664-4635
Mailing Address - Street 1:6130 SHALLOWFORD RD
Mailing Address - Street 2:STE 101
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-7222
Mailing Address - Country:US
Mailing Address - Phone:423-664-4635
Mailing Address - Fax:423-664-4640
Practice Address - Street 1:1012 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-3993
Practice Address - Country:US
Practice Address - Phone:423-664-4635
Practice Address - Fax:423-664-4640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-05
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3373967Medicare PIN