Provider Demographics
NPI:1992118939
Name:SPINAL PAIN CENTER, PLLC
Entity type:Organization
Organization Name:SPINAL PAIN CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:PELMORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-285-9284
Mailing Address - Street 1:1037 S ROANE ST
Mailing Address - Street 2:PO BOX 1137
Mailing Address - City:HARRIMAN
Mailing Address - State:TN
Mailing Address - Zip Code:37748-7427
Mailing Address - Country:US
Mailing Address - Phone:865-285-9284
Mailing Address - Fax:865-882-3664
Practice Address - Street 1:1037 S ROANE ST
Practice Address - Street 2:
Practice Address - City:HARRIMAN
Practice Address - State:TN
Practice Address - Zip Code:37748-7427
Practice Address - Country:US
Practice Address - Phone:865-285-9284
Practice Address - Fax:865-882-3664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-06
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP3300X
TN16534363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain