Healthcare Provider Details

I. General information

NPI: 1336695725
Provider Name (Legal Business Name): NORTHVIEW PAIN TREATMENT CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2016
Last Update Date: 08/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15650 N BLACK CANYON HWY B121
PHOENIX AZ
85053-4064
US

IV. Provider business mailing address

15650 N BLACK CANYON HWY B121
PHOENIX AZ
85053-4064
US

V. Phone/Fax

Practice location:
  • Phone: 480-440-1985
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. CHELSEY KERCHANSKY
Title or Position: FACILITY ADMINISTRATOR
Credential: MPH
Phone: 480-440-1985