Healthcare Provider Details

I. General information

NPI: 1316192602
Provider Name (Legal Business Name): ARIZONA PAIN SPECIALISTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2008
Last Update Date: 06/23/2022
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18555 N 79TH AVE SUITE E101
GLENDALE AZ
85308-8370
US

IV. Provider business mailing address

PO BOX 6408
SCOTTSDALE AZ
85261-6408
US

V. Phone/Fax

Practice location:
  • Phone: 623-878-7246
  • Fax: 623-878-7245
Mailing address:
  • Phone: 480-563-6400
  • Fax: 480-563-8009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number41788
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number35497
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number36803
License Number StateAZ

VIII. Authorized Official

Name: PAUL LYNCH
Title or Position: CEO
Credential: MD
Phone: 480-563-6400