Healthcare Provider Details

I. General information

NPI: 1861575078
Provider Name (Legal Business Name): PAIN INSTITUTE OF SOUTHERN ARIZONA PISA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 03/21/2022
Certification Date: 03/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4582 N FIRST AVE STE 170
TUCSON AZ
85718-8607
US

IV. Provider business mailing address

4881 E GRANT RD
TUCSON AZ
85712-2704
US

V. Phone/Fax

Practice location:
  • Phone: 520-318-6035
  • Fax: 520-795-9953
Mailing address:
  • Phone: 520-318-6035
  • Fax: 520-795-9953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JENNIFER L IRWIN
Title or Position: CONTROLLER
Credential:
Phone: 520-829-6776