Healthcare Provider Details

I. General information

NPI: 1841792983
Provider Name (Legal Business Name): SCOTTSDALE PAIN SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2018
Last Update Date: 11/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2629 N SCOTTSDALE RD
SCOTTSDALE AZ
85257-1370
US

IV. Provider business mailing address

4300 N MILLER RD STE 240
SCOTTSDALE AZ
85251-3639
US

V. Phone/Fax

Practice location:
  • Phone: 480-306-7227
  • Fax:
Mailing address:
  • Phone: 480-306-7227
  • Fax: 480-306-7238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL CORMIER
Title or Position: MANAGING MEMBER
Credential: DC
Phone: 480-306-7227