Healthcare Provider Details

I. General information

NPI: 1255840914
Provider Name (Legal Business Name): INTEGRATED PAIN AND SPINE OTC ,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13203 N 103RD AVE STE H5
SUN CITY AZ
85351-3032
US

IV. Provider business mailing address

13203 N 103RD AVE STE H5
SUN CITY AZ
85351-3032
US

V. Phone/Fax

Practice location:
  • Phone: 623-777-4747
  • Fax:
Mailing address:
  • Phone: 623-777-4747
  • Fax:

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: CLIFFORD BAKER
Title or Position: MD/OWNER
Credential: MD
Phone: 623-777-4747