Basic Information
| Provider Information | |||||||||
| NPI: | 1891375770 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PREMIER PAIN & SPINE CENTER, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3443 DICKERSON PIKE STE 590 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372072520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6156377463 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3443 DICKERSON PIKE STE 590 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372072520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6159888100 | ||||||||
| FaxNumber: | 8772965238 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2021 | ||||||||
| LastUpdateDate: | 08/03/2021 | ||||||||
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| AuthorizedOfficialLastName: | SCHMIDT | ||||||||
| AuthorizedOfficialFirstName: | ALEX | ||||||||
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| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 6159888100 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 08/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QH0100X | N | Ambulatory Health Care Facilities | Clinic/Center | Health Service | 261QP3300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Pain |
ID Information
| ID | Type | State | Issuer | Description | Q066517 | 05 | TN | MEDICAID |