Provider Demographics
NPI:1780999037
Name:SPECTRUM PAIN CLINICS, INC
Entity type:Organization
Organization Name:SPECTRUM PAIN CLINICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GIOVANNI
Authorized Official - Middle Name:
Authorized Official - Last Name:FACCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-794-5009
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37065-0190
Mailing Address - Country:US
Mailing Address - Phone:615-794-5009
Mailing Address - Fax:615-790-7531
Practice Address - Street 1:230 EAST JAMES CAMPBELL BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401
Practice Address - Country:US
Practice Address - Phone:931-840-9588
Practice Address - Fax:615-790-7531
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPECTRUM PAIN CLINICS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3372106Medicare PIN