Provider Demographics
NPI:1194964163
Name:HENDERSONVILLE SPINE AND PAIN CENTER, P.C.
Entity type:Organization
Organization Name:HENDERSONVILLE SPINE AND PAIN CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DC
Authorized Official - Prefix:
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-824-1474
Mailing Address - Street 1:639 E MAIN ST BLDG A
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-2646
Mailing Address - Country:US
Mailing Address - Phone:615-824-1474
Mailing Address - Fax:615-824-1019
Practice Address - Street 1:639 E MAIN ST BLDG A
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-2646
Practice Address - Country:US
Practice Address - Phone:615-824-1474
Practice Address - Fax:615-824-1019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-13
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty