Basic Information
| Provider Information | |||||||||
| NPI: | 1649554759 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PINNACLE PAIN MANAGEMENT, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 SHERRILL ST | ||||||||
| Address2: | SUITE B | ||||||||
| City: | UNION CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 382615891 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7318843900 | ||||||||
| FaxNumber: | 7318843901 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 SHERRILL ST | ||||||||
| Address2: | SUITE B | ||||||||
| City: | UNION CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 382615891 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7318843900 | ||||||||
| FaxNumber: | 7318843901 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2011 | ||||||||
| LastUpdateDate: | 04/26/2012 | ||||||||
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| AuthorizedOfficialLastName: | KELLER | ||||||||
| AuthorizedOfficialFirstName: | JASON | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7318843900 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0014X | 1368 | TN | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
No ID Information.