Basic Information
| Provider Information | |||||||||
| NPI: | 1710928510 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TENNESSEE VALLEY PAIN CONSULTANTS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 11407 | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352460116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565337064 | ||||||||
| FaxNumber: | 2567040115 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 GOVERNORS DR. | ||||||||
| Address2: | 4TH FLOOR | ||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2562657246 | ||||||||
| FaxNumber: | 2562657017 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2006 | ||||||||
| LastUpdateDate: | 01/06/2009 | ||||||||
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| AuthorizedOfficialLastName: | SCHERLIS | ||||||||
| AuthorizedOfficialFirstName: | MORRIS | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2562657246 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | 207L00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 529601880 | 05 | AL | MEDICAID |