MEDICARE: CENTER FOR PAIN MANAGEMENT LLC

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	261QA1903X	Ambulatory Surgical Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OTC9330	OTHER	AZ	STATE LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891717195
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR PAIN MANAGEMENT LLC

Provider Business Mailing Address
First Line	:	PO BOX 841205
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-1205
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4745 E CAMP LOWELL DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-1256
Country	:	US
Telephone Number	:	520-506-0100
Fax Number	:	520-485-5440

Authorized Official
Title or Position	:	DIRECTOR OF PROVIDER ENROLLMENT
Name	:	KRISTINA MUSIC
Credential	:
Telephone Number	:	615-465-7377

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	08/14/2024

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Directions to “CENTER FOR PAIN MANAGEMENT LLC ” Practice Location

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