Healthcare Provider Details

I. General information

NPI: 1649407180
Provider Name (Legal Business Name): PAIN MDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2009
Last Update Date: 09/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 W CAREFREE HWY STE 134
PHOENIX AZ
85085
US

IV. Provider business mailing address

2525 W CAREFREE HWY SUITE 134, BUILDING 5
PHOENIX AZ
85085-6093
US

V. Phone/Fax

Practice location:
  • Phone: 623-580-4357
  • Fax: 623-580-5249
Mailing address:
  • Phone: 623-580-4357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateAZ

VIII. Authorized Official

Name: PAUL ANTHONY PANNOZZO
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 623-776-8686