Healthcare Provider Details

I. General information

NPI: 1255603775
Provider Name (Legal Business Name): PREMIER PAIN SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2012
Last Update Date: 04/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10255 N 32ND ST
PHOENIX AZ
85028-3851
US

IV. Provider business mailing address

2813 E CAMELBACK RD SUITE 430
PHOENIX AZ
85016-4325
US

V. Phone/Fax

Practice location:
  • Phone: 602-354-5659
  • Fax: 602-354-5896
Mailing address:
  • Phone: 602-354-5659
  • Fax: 602-354-5896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberOSC5336
License Number StateAZ

VIII. Authorized Official

Name: VICKI BELT
Title or Position: OWNER
Credential:
Phone: 602-354-5659