Provider Demographics
NPI:1134522857
Name:PAIN MD LLC
Entity type:Organization
Organization Name:PAIN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE COUNSEL
Authorized Official - Prefix:MR
Authorized Official - First Name:CARROLL
Authorized Official - Middle Name:E
Authorized Official - Last Name:COMBS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:615-435-0553
Mailing Address - Street 1:PO BOX 681789
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-1789
Mailing Address - Country:US
Mailing Address - Phone:615-503-9000
Mailing Address - Fax:
Practice Address - Street 1:1950 US HIGHWAY 51 BYP N
Practice Address - Street 2:STE. C
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-1896
Practice Address - Country:US
Practice Address - Phone:731-286-4118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-08
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7259360006Medicare NSC
TNQ005805Medicaid