Healthcare Provider Details

I. General information

NPI: 1134331325
Provider Name (Legal Business Name): TUCSON INTERVENTIONAL PAIN MANAGEMENT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 12/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 E ERICKSON DR SUITE 116
TUCSON AZ
85712-2828
US

IV. Provider business mailing address

PO BOX 32216
TUCSON AZ
85751-2216
US

V. Phone/Fax

Practice location:
  • Phone: 520-299-8200
  • Fax:
Mailing address:
  • Phone: 520-299-8200
  • Fax: 520-299-8202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ROBERT J. BERENS
Title or Position: OWNER
Credential: MD
Phone: 602-273-6770