Provider Demographics
NPI:1649554759
Name:PINNACLE PAIN MANAGEMENT, PLLC
Entity type:Organization
Organization Name:PINNACLE PAIN MANAGEMENT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:T
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:731-884-3900
Mailing Address - Street 1:700 SHERRILL ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:UNION CITY
Mailing Address - State:TN
Mailing Address - Zip Code:38261-5891
Mailing Address - Country:US
Mailing Address - Phone:731-884-3900
Mailing Address - Fax:731-884-3901
Practice Address - Street 1:700 SHERRILL ST
Practice Address - Street 2:SUITE B
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-5891
Practice Address - Country:US
Practice Address - Phone:731-884-3900
Practice Address - Fax:731-884-3901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-07
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1368208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103G702733Medicare PIN