Provider Demographics
NPI:1962655696
Name:PAIN MEDICINE ASSOCIATES, P.C.
Entity type:Organization
Organization Name:PAIN MEDICINE ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAYS
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:423-232-6120
Mailing Address - Street 1:101 MED TECH PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-4007
Mailing Address - Country:US
Mailing Address - Phone:423-232-6120
Mailing Address - Fax:423-232-6125
Practice Address - Street 1:101 MED TECH PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-4007
Practice Address - Country:US
Practice Address - Phone:423-232-6120
Practice Address - Fax:423-232-6125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1084103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3715213Medicaid
TN134016XXOtherPREFERRED CARE
TNCG3754OtherMEDICARE RAILROAD
TN373941500OtherDEPT OF LABOR
TN146990OtherANTHEM VA - BRISTOL
TN146991OtherANTHEM VA - KPT
TN146990OtherANTHEM VA - BRISTOL