=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053366989
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PAIN CENTERS NATIONWIDE, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2006
-----------------------------------------------------
Last Update Date | 04/10/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8877 W UNION HILLS DR STE 200
-----------------------------------------------------
City | PEORIA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85382-3016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-776-8686
-----------------------------------------------------
Fax | 623-776-8687
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8877 W UNION HILLS DR 200
-----------------------------------------------------
City | PEORIA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85382-3008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-776-8686
-----------------------------------------------------
Fax | 623-776-8687
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. PAUL ANTHONY PANNOZZO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 623-776-8686
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | 31052
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------