Provider Demographics
NPI:1720541402
Name:TENNESSEE INTEGRATIVE PAIN INSTITUTE PLC
Entity Type:Organization
Organization Name:TENNESSEE INTEGRATIVE PAIN INSTITUTE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-229-7202
Mailing Address - Street 1:2042 LASCASSAS PIKE STE A4
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-2034
Mailing Address - Country:US
Mailing Address - Phone:615-229-7202
Mailing Address - Fax:
Practice Address - Street 1:2042 LASCASSAS PIKE STE A4
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-2034
Practice Address - Country:US
Practice Address - Phone:615-229-7202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-10
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1511689Medicaid