Healthcare Provider Details

I. General information

NPI: 1871650739
Provider Name (Legal Business Name): THE PAIN CENTER OF ARIZONA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20333 N 19TH AVE STE 100
PHOENIX AZ
85027-3602
US

IV. Provider business mailing address

5281 N 99TH AVE STE 100
GLENDALE AZ
85305-2209
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 TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

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