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Contact Information

SOUTHEASTERN PAIN PLLC
1236 KNOXVILLE HWY
WARTBURG, TN37887
 Phone: 770-548-2182
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pain Medicine

207LP2900X 05 Physician/Anesthesiology
Indicates primary specialty

NPI Profile & details for SOUTHEASTERN PAIN PLLC

NPI Number 1992217723
LBN Legal business name SOUTHEASTERN PAIN PLLC
Authorized official GARY BLACK - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 11/02/2017
Last updated 06/01/2018 - About 8 years ago
Identifiers
TN Medicaid Q035114
TN Other 0099 MEDICARE PTAN
TN Other DY2044 RRMEDICARE PTAN
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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