Provider Demographics
NPI:1679979959
Name:ECLIPSE PAIN NETWORK, LLC
Entity Type:Organization
Organization Name:ECLIPSE PAIN NETWORK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:931-919-2812
Mailing Address - Street 1:PO BOX 3930
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-0930
Mailing Address - Country:US
Mailing Address - Phone:931-919-2812
Mailing Address - Fax:931-919-2810
Practice Address - Street 1:226 UFFELMAN DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4974
Practice Address - Country:US
Practice Address - Phone:931-919-2812
Practice Address - Fax:931-919-2810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ006043Medicaid
TN103I110353Medicare Oscar/Certification