Basic Information
| Provider Information | |||||||||
| NPI: | 1265459192 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WEST TENNESSEE PAIN SPECIALISTS PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 10667 | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383080111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7316602056 | ||||||||
| FaxNumber: | 7316619092 | ||||||||
| Practice Location | |||||||||
| Address1: | 15 STONEBRIDGE BLVD | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383052042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7316602056 | ||||||||
| FaxNumber: | 7316619092 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2006 | ||||||||
| LastUpdateDate: | 10/23/2020 | ||||||||
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| AuthorizedOfficialLastName: | SCHMIDT | ||||||||
| AuthorizedOfficialFirstName: | ROY | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/MD | ||||||||
| AuthorizedOfficialTelephone: | 7316602056 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 10/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | 0000022099 | TN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.