Basic Information
| Provider Information | |||||||||
| NPI: | 1487075099 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASSOCIATED PAIN SPECIALISTS, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1326 PAPERMILL POINTE WAY | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379091903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655583476 | ||||||||
| FaxNumber: | 8653306323 | ||||||||
| Practice Location | |||||||||
| Address1: | 1342 PAPERMILL POINTE WAY | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379091903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8656735000 | ||||||||
| FaxNumber: | 8653306323 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2013 | ||||||||
| LastUpdateDate: | 12/06/2021 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ODELL | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | HARLEY | ||||||||
| AuthorizedOfficialTitleorPosition: | SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 8656735000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 12/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WW0000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Nursing Service Providers | Registered Nurse | Wound Care | 261QM1300X | N | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | 332900000X | 4447050 | TN | N | Suppliers | Non-Pharmacy Dispensing Site | 332B00000X | 7068360001 | TN | N | Suppliers | Durable Medical Equipment & Medical Supplies | 208VP0000X | 00000206 | TN | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | Q002176 | 05 | TN | MEDICAID | Q002178 | 05 | TN | MEDICAID |