Healthcare Provider Details

I. General information

NPI: 1689843963
Provider Name (Legal Business Name): PAIN-MDS AMBULATORY SURGICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2008
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16390 N. 59TH AVE SUITE 100
GLENDALE AZ
85306
US

IV. Provider business mailing address

16390 N 59TH AVE STE 100
GLENDALE AZ
85306-1711
US

V. Phone/Fax

Practice location:
  • Phone: 623-334-4000
  • Fax: 623-334-4400
Mailing address:
  • Phone: 623-334-4000
  • Fax: 623-334-4400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateAZ

VIII. Authorized Official

Name: MRS. JANNA WELLS
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 623-334-4000