Organization
CLEVELAND PAIN MANAGEMENT, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY DEROOS D.C. (PRESIDENT)
(423) 614-5654
Entity
Organization
Contact information
Practice address
340 SUNSET DR NW, CLEVELAND, TN 37312-5349
(423) 614-5654
(423) 614-5645
Mailing address
340 SUNSET DR NW, CLEVELAND, TN 37312-5349
(423) 614-5654
(423) 614-5645
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
1294
TN
208D00000X
General Practice Physician
Primary
9519
TN
363A00000X
Physician Assistant
1753
TN
363A00000X
Physician Assistant
1830
TN
363L00000X
Nurse Practitioner
15022
TN
363LA2100X
Acute Care Nurse Practitioner
13925
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1513537
—
TN
01
—
3730366
MEDICARE
TN
01
—
4026063
BCBSTN
TN
Enumeration date
12/17/2008
Last updated
08/03/2010
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