Healthcare Provider Details

I. General information

NPI: 1104449628
Provider Name (Legal Business Name): THE PAIN INSTITUTE OF SOUTHERN ARIZONA PISA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2020
Last Update Date: 01/28/2021
Certification Date: 08/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2241 W 16TH STREET
SAFFORD AZ
85546
US

IV. Provider business mailing address

4881 E GRANT ROAD SUITE 101
TUCSON AZ
85712-2704
US

V. Phone/Fax

Practice location:
  • Phone: 520-829-6900
  • Fax: 520-829-6661
Mailing address:
  • Phone: 520-318-6035
  • Fax: 520-829-6661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN H COLE
Title or Position: CEO
Credential:
Phone: 520-829-6776