Provider Demographics
NPI:1982146361
Name:PAIN MANAGEMENT OF MIDDLE TENNESSEE PLLC
Entity Type:Organization
Organization Name:PAIN MANAGEMENT OF MIDDLE TENNESSEE PLLC
Other - Org Name:ANESTHESIA MEDICAL GROUP PAIN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:A
Authorized Official - Last Name:FORREST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-327-4304
Mailing Address - Street 1:110 29TH AVE N
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1401
Mailing Address - Country:US
Mailing Address - Phone:615-327-4340
Mailing Address - Fax:615-327-7940
Practice Address - Street 1:330 23RD AVE N
Practice Address - Street 2:SUITE 130
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1534
Practice Address - Country:US
Practice Address - Phone:615-620-1650
Practice Address - Fax:615-620-1654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-16
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7568020001Medicare NSC