Provider Demographics
NPI:1922230986
Name:SOUTHERN PAIN INSTITUTE PLLC
Entity Type:Organization
Organization Name:SOUTHERN PAIN INSTITUTE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA-LOUISE
Authorized Official - Middle Name:O
Authorized Official - Last Name:MOLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-459-3244
Mailing Address - Street 1:PO BOX 50053
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-0053
Mailing Address - Country:US
Mailing Address - Phone:615-459-3244
Mailing Address - Fax:615-459-6525
Practice Address - Street 1:5073 MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-2737
Practice Address - Country:US
Practice Address - Phone:615-459-3244
Practice Address - Fax:615-459-6525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-10
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN342312081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3370146Medicare PIN