Healthcare Provider Details

I. General information

NPI: 1073127858
Provider Name (Legal Business Name): FLAGSTAFF PAIN & TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2020
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 N SAN FRANCISCO ST
FLAGSTAFF AZ
86001-3294
US

IV. Provider business mailing address

610 E BASELINE RD
TEMPE AZ
85283-1204
US

V. Phone/Fax

Practice location:
  • Phone: 602-903-0360
  • Fax:
Mailing address:
  • Phone: 602-903-0360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SUSAN L NANCE
Title or Position: COO
Credential: RN
Phone: 602-903-0360