Healthcare Provider Details

I. General information

NPI: 1174700975
Provider Name (Legal Business Name): PREMIER PAIN MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2008
Last Update Date: 10/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4540 E BASELINE RD STE 112
MESA AZ
85206-4616
US

IV. Provider business mailing address

4540 E BASELINE RD STE 105
MESA AZ
85206-4616
US

V. Phone/Fax

Practice location:
  • Phone: 480-272-8944
  • Fax: 480-237-5682
Mailing address:
  • Phone: 480-272-8944
  • Fax: 480-237-5682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License NumberOTC4333
License Number StateAZ

VIII. Authorized Official

Name: DR. JAMES SIEFFERT
Title or Position: CLINICAL ADMINISTRATOR
Credential: DC
Phone: 280-272-8944