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Organization

PHYSICIAN ASSOCIATE INTERDISCIPLINARY CLINIC (PAIN-C)

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MAURICE SKILLERN DMS, PA-C (PRESIDENT / CEO)
(706) 536-3272
Entity
Organization

Contact information

Practice address
4131 KIRBY PKWY STE 1, KIRBY-RAINES MEDICAL CENTER, MEMPHIS, TN 38115-3206
(706) 536-3272
Mailing address
4131 KIRBY PKWY STE 1, MEMPHIS, TN 38115-6500
(706) 536-3272

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1805
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1407373210
CLINIC NPI NUMBER
Enumeration date
08/23/2017
Last updated
11/10/2021
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