Healthcare Provider Details

I. General information

NPI: 1437234465
Provider Name (Legal Business Name): PAIN CONSULTANTS OF ARIZONA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 08/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20950 N TATUM BLVD STE 100
PHOENIX AZ
85050-4204
US

IV. Provider business mailing address

20950 N TATUM BLVD SUITE 300
PHOENIX AZ
85050-4200
US

V. Phone/Fax

Practice location:
  • Phone: 480-222-7246
  • Fax: 480-222-7271
Mailing address:
  • Phone: 480-222-7246
  • Fax: 602-322-1684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number28310
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number4087
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number28310
License Number StateAZ

VIII. Authorized Official

Name: PETER KUBITZ
Title or Position: DO
Credential: DO
Phone: 480-222-7246