SOUTHEASTERN PAIN PLLC NPI 1992217723

NPI Information

  • NPI: 1992217723
  • Provider Name: SOUTHEASTERN PAIN PLLC
  • Classification: Anesthesiology - 207LP2900X
  • Specialization: Pain Medicine
  • Entity Type: Organization
  • CLIA Number: 11D2290796
  • Address: 1236 KNOXVILLE HWY
    WARTBURG, TN
    ZIP 37887
  • Phone: (770) 548-2182

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NPI Details

SOUTHEASTERN PAIN PLLC is a pain medicine anesthesiology in Wartburg, TN. The provider is an anesthesiologist who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic and/or cancer pain in both hospital and ambulatory settings. Patient care needs are also coordinated with other specialists. SOUTHEASTERN PAIN PLLC NPI is 1992217723. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1236 KNOXVILLE HWY
WARTBURG, TN
ZIP 37887
Phone: (770) 548-2182

The provider's authorized official is Gary Chase Black .
The authorized official title is Owner and has the following contact phone number (770) 548-2182.

The CLIA number assigned to this NPI record is 11D2290796 - ambulance with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/2/2017 and was last updated on 6/1/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207LP2900XAnesthesiologyPain MedicineYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1DY2044OTHERTENNESSEERRMEDICARE PTAN
20099OTHERTENNESSEEMEDICARE PTAN
3Q035114MEDICAIDTENNESSEE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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