Healthcare Provider Details

I. General information

NPI: 1609066885
Provider Name (Legal Business Name): OMNIA PAIN CONSULTANTS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 12/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5051 E THOMAS RD
PHOENIX AZ
85018-5408
US

IV. Provider business mailing address

4400 N SCOTTSDALE RD SUITE 9717
SCOTTSDALE AZ
85251-3331
US

V. Phone/Fax

Practice location:
  • Phone: 480-473-7246
  • Fax: 480-473-4942
Mailing address:
  • Phone: 480-473-7246
  • Fax: 480-473-4942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number28663
License Number StateAZ

VIII. Authorized Official

Name: BILAL F. SHANTI
Title or Position: OWNER
Credential: MD
Phone: 480-473-7246