Healthcare Provider Details

I. General information

NPI: 1740514538
Provider Name (Legal Business Name): HEALTH & PAIN CENTRE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2009
Last Update Date: 11/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7254 E SOUTHERN AVE #105
MESA AZ
85209-2786
US

IV. Provider business mailing address

7254 E SOUTHERN AVE. #105
MESA AZ
85209-2787
US

V. Phone/Fax

Practice location:
  • Phone: 480-924-3200
  • Fax: 480-985-2546
Mailing address:
  • Phone: 480-924-3200
  • Fax: 480-985-2546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN082346
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number#8308
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number8308
License Number StateAZ

VIII. Authorized Official

Name: MRS. JULIE A STOTT
Title or Position: CO-OWNER
Credential: NP-C
Phone: 480-924-3200