Healthcare Provider Details

I. General information

NPI: 1104009265
Provider Name (Legal Business Name): THE CENTER FOR PAIN AND SUPPORTIVE CARE P L L C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2007
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4611 E. SHEA BLVD. BLDG. 3 SUITE 190
PHOENIX AZ
85028-4258
US

IV. Provider business mailing address

4611 E. SHEA BLVD. BLDG. 3 SUITE 170
PHOENIX AZ
85028-4258
US

V. Phone/Fax

Practice location:
  • Phone: 480-889-0180
  • Fax: 480-889-0186
Mailing address:
  • Phone: 480-889-0180
  • Fax: 480-889-0186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LH0002X
TaxonomyHospice and Palliative Medicine (Anesthesiology) Physician
License Number24521
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number24521
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number24521
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number24521
License Number StateAZ

VIII. Authorized Official

Name: DR. GOBI PARAMANANDAM
Title or Position: MEMBER MANAGER
Credential:
Phone: 480-889-0180