Healthcare Provider Details

I. General information

NPI: 1396339941
Provider Name (Legal Business Name): PALOVERDE ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2021
Last Update Date: 02/24/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5533 E BELL RD STE 111
SCOTTSDALE AZ
85254-1256
US

IV. Provider business mailing address

5533 E BELL RD STE 111
SCOTTSDALE AZ
85254-1256
US

V. Phone/Fax

Practice location:
  • Phone: 602-788-4200
  • Fax: 602-788-4208
Mailing address:
  • Phone: 602-788-4200
  • Fax: 602-788-4208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JUSTIN PIERCE
Title or Position: OWNER
Credential: DC
Phone: 517-214-2501