Healthcare Provider Details

I. General information

NPI: 1598478844
Provider Name (Legal Business Name): PAINLESS PEACH PAIN CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2023
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 N WEST ST STE 200B
FLAGSTAFF AZ
86004-1651
US

IV. Provider business mailing address

3100 N WEST ST STE 200B
FLAGSTAFF AZ
86004-1651
US

V. Phone/Fax

Practice location:
  • Phone: 928-389-9041
  • Fax: 928-389-9042
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: SANDRA ADAMS
Title or Position: OWNER
Credential:
Phone: 928-389-9041