Provider Demographics
NPI:1760803324
Name:ASSOCIATED PAIN SPECIALISTS, PC
Entity Type:Organization
Organization Name:ASSOCIATED PAIN SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:O'DELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:865-558-3476
Mailing Address - Street 1:1326 PAPERMILL POINTE WAY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1903
Mailing Address - Country:US
Mailing Address - Phone:865-558-3476
Mailing Address - Fax:865-330-6323
Practice Address - Street 1:2103 FOREST DR STE 5
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:TN
Practice Address - Zip Code:37615-8423
Practice Address - Country:US
Practice Address - Phone:423-794-3142
Practice Address - Fax:423-794-3184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-30
Last Update Date:2023-08-28
Deactivation Date:2023-08-17
Deactivation Code:
Reactivation Date:2023-08-28
Provider Licenses
StateLicense IDTaxonomies
TN00000456208VP0000X
261QM1300X
TN7068360002332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ002178Medicaid
TN7068360002Medicare NSC
TN10370G8339Medicare PIN