Healthcare Provider Details

I. General information

NPI: 1710368410
Provider Name (Legal Business Name): THE PAIN CENTER OF ARIZONA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2015
Last Update Date: 06/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9401 W THUNDERBIRD RD SUITE 180
PEORIA AZ
85381-4233
US

IV. Provider business mailing address

5281 N 99TH AVE SUITE 100
GLENDALE AZ
85305-3105
US

V. Phone/Fax

Practice location:
  • Phone: 623-516-8252
  • Fax: 623-516-8253
Mailing address:
  • Phone: 623-516-8252
  • Fax: 623-516-8253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: CATHY HARDESTY
Title or Position: DIRECTOR OF ADMIN OPERATIONS
Credential:
Phone: 623-241-6101