Provider Demographics
NPI:1972770063
Name:STEPHEN V. DRESKIN MD PC
Entity Type:Organization
Organization Name:STEPHEN V. DRESKIN MD PC
Other - Org Name:TN VALLEY PAIN MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:S
Authorized Official - Last Name:CLAPP
Authorized Official - Suffix:
Authorized Official - Credentials:EMT, CMA, CPC
Authorized Official - Phone:423-664-4635
Mailing Address - Street 1:1949 GUNBARREL RD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-3188
Mailing Address - Country:US
Mailing Address - Phone:423-664-4635
Mailing Address - Fax:423-664-4640
Practice Address - Street 1:2700 WESTSIDE DR NW
Practice Address - Street 2:SUITE 306
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-3699
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:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26298208VP0000X
TN26240208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3882406Medicaid
TN3088189Medicaid
TN3671003Medicaid
TN3642504Medicaid
TN3671003Medicare PIN
TN3671003Medicaid
TNQ12121Medicare UPIN
TNQ64218Medicare UPIN
TN3088189Medicaid
TN3882406Medicaid
TN3882406Medicare PIN
TN3088189Medicare PIN