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NPI Code Detail

MEDICARE: ANTHEM PAIN MANAGEMENT, LLC

MEDICARE: ANTHEM 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
1302R00000XHealth Maintenance OrganizationAP3009AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1AP3009OTHERAZAZ NP LICENSE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1972910990
Entity Type Code : Organization
Provider Name (Legal Business Name) : ANTHEM PAIN MANAGEMENT, LLC
Provider Business Mailing Address
First Line : 41818 N VENTURE DR STE 150
Second Line :
City : ANTHEM
State : AZ
Zip : 85086-3190
Country : US
Telephone Number : 716-812-6664
Fax Number :
Provider Business Practice Location Address
First Line : 41818 N VENTURE DR STE 150
Second Line :
City : ANTHEM
State : AZ
Zip : 85086-3190
Country : US
Telephone Number : 623-341-8469
Fax Number : 623-551-6900
Authorized Official
Title or Position : FAMILY NURSE PRACTITIONER
Name : KEITH R SUTTON
Credential : FNP
Telephone Number : 623-341-8469
Provider Enumeration Date : 07/22/2014
Last Update Date : 12/05/2025

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Directions to “ANTHEM PAIN MANAGEMENT, LLC ” Practice Location

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