MEDICARE: FLAGSTAFF PAIN & TREATMENT CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician
2	207LP2900X	Pain Medicine (Anesthesiology) Physician

General Provider Information

NPI Number	:	1073127858
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLAGSTAFF PAIN & TREATMENT CENTER

Provider Business Mailing Address
First Line	:	610 E BASELINE RD
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85283-1204
Country	:	US
Telephone Number	:	602-903-0360
Fax Number	:

Provider Business Practice Location Address
First Line	:	823 N SAN FRANCISCO ST
Second Line	:
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86001-3294
Country	:	US
Telephone Number	:	602-903-0360
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	SUSAN L NANCE
Credential	:	RN
Telephone Number	:	602-903-0360

Provider Enumeration Date	:	08/31/2020
Last Update Date	:	03/27/2026

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Directions to “FLAGSTAFF PAIN & TREATMENT CENTER ” Practice Location

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