Healthcare Provider Details

I. General information

NPI: 1205420288
Provider Name (Legal Business Name): PIONEER PAIN SPECIALISTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2021
Last Update Date: 02/22/2021
Certification Date: 02/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3011 S LINDSAY RD STE 113
GILBERT AZ
85295-4334
US

IV. Provider business mailing address

3011 S LINDSAY RD STE 113
GILBERT AZ
85295-4334
US

V. Phone/Fax

Practice location:
  • Phone: 480-377-4360
  • Fax:
Mailing address:
  • Phone: 480-377-4360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KENDRICK THOMAS
Title or Position: MD, OWNER
Credential:
Phone: 480-377-4360