Basic Information
| Provider Information | |||||||||
| NPI: | 1154386282 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JOHN L STANTON MD PC | ||||||||
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| OtherOrganizationName: | THE JOINT AND SPINE PAIN CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 980 PROFESSIONAL PARK DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | CLARKSVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370405251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9319051005 | ||||||||
| FaxNumber: | 9319050410 | ||||||||
| Practice Location | |||||||||
| Address1: | 351 DOVER RD | ||||||||
| Address2: | SUITE B | ||||||||
| City: | CLARKSVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370424144 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9319051005 | ||||||||
| FaxNumber: | 9319050410 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2006 | ||||||||
| LastUpdateDate: | 09/26/2016 | ||||||||
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| AuthorizedOfficialLastName: | SCHMIDT | ||||||||
| AuthorizedOfficialFirstName: | TAMIKKA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9319051001 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | 207XX0005X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 65940645 | 01 | KY | KENTUCKY MEDICAID | OTHER | 3376845 | 05 | TN | MEDICAID |