Provider Demographics
NPI:1154386282
Name:THE JOINT AND SPINE PAIN CENTER
Entity type:Organization
Organization Name:THE JOINT AND SPINE PAIN CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NIKKI
Authorized Official - Middle Name:
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-919-3813
Mailing Address - Street 1:980 PROFESSIONAL PARK DR STE C
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-5251
Mailing Address - Country:US
Mailing Address - Phone:931-919-3813
Mailing Address - Fax:931-919-3813
Practice Address - Street 1:980 PROFESSIONAL PARK DR STE C
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-5251
Practice Address - Country:US
Practice Address - Phone:931-919-3813
Practice Address - Fax:931-919-3813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3376845Medicaid
KY65940645OtherKENTUCKY MEDICAID
TN3376845Medicare PIN
TN3376845Medicaid
KY65940645OtherKENTUCKY MEDICAID