Healthcare Provider Details

I. General information

NPI: 1518381037
Provider Name (Legal Business Name): CONCIERGE PAIN MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2014
Last Update Date: 08/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10025 E DYNAMITE BLVD B130
SCOTTSDALE AZ
85262-3688
US

IV. Provider business mailing address

10025 E DYNAMITE BLVD B145
SCOTTSDALE AZ
85262-3688
US

V. Phone/Fax

Practice location:
  • Phone: 480-419-1189
  • Fax:
Mailing address:
  • Phone: 480-419-1189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALEXANDER CLAY BIGHAM
Title or Position: CEO
Credential: D.C
Phone: 480-419-1189