Healthcare Provider Details

I. General information

NPI: 1619147865
Provider Name (Legal Business Name): PAIN MANAGEMENT CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2008
Last Update Date: 03/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9787 N 91ST ST SUITE 101
SCOTTSDALE AZ
85258-5088
US

IV. Provider business mailing address

9787 N 91ST ST SUITE 101
SCOTTSDALE AZ
85258-5088
US

V. Phone/Fax

Practice location:
  • Phone: 480-860-8300
  • Fax: 480-860-8398
Mailing address:
  • Phone: 480-860-8300
  • Fax: 480-860-8398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number17082
License Number StateAZ

VIII. Authorized Official

Name: MRS. PATRICIA TURRENTINE
Title or Position: CLINIC DIRECTOR
Credential:
Phone: 480-505-4207