Healthcare Provider Details

I. General information

NPI: 1013582279
Provider Name (Legal Business Name): INTEGRATED PAIN CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2021
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20045 N 19TH AVE STE 3
PHOENIX AZ
85027-4265
US

IV. Provider business mailing address

9500 E IRONWOOD SQUARE DR STE 125
SCOTTSDALE AZ
85258-4582
US

V. Phone/Fax

Practice location:
  • Phone: 480-626-2552
  • Fax:
Mailing address:
  • Phone: 602-377-7749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MONICA RYAN
Title or Position: COO
Credential: COO
Phone: 480-626-2552