Provider Demographics
NPI:1306237938
Name:LIFELINC PAIN MANAGEMENT PLLC
Entity type:Organization
Organization Name:LIFELINC PAIN MANAGEMENT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:CALLAN
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:901-844-1590
Mailing Address - Street 1:3340 PLAYERS CLUB PKWY
Mailing Address - Street 2:SUITE 350
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-8933
Mailing Address - Country:US
Mailing Address - Phone:901-844-1590
Mailing Address - Fax:901-844-1592
Practice Address - Street 1:308 NORTHCREST DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:TN
Practice Address - Zip Code:37172-3963
Practice Address - Country:US
Practice Address - Phone:866-362-6963
Practice Address - Fax:866-362-4202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-18
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN207LP2900X, 363L00000X, 367500000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ013363Medicaid
TN103G707000Medicare PIN