Healthcare Provider Details

I. General information

NPI: 1144842485
Provider Name (Legal Business Name): SOUTHWEST PAIN SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2020
Last Update Date: 03/17/2021
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1940 E THUNDERBIRD RD STE 103
PHOENIX AZ
85022-5760
US

IV. Provider business mailing address

6401 E CARON DR
PARADISE VALLEY AZ
85253-1862
US

V. Phone/Fax

Practice location:
  • Phone: 480-478-0790
  • Fax:
Mailing address:
  • Phone: 623-293-3985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: CHRISTOPHER RAY
Title or Position: PRESIDENT
Credential: MD
Phone: 623-293-3985