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General NPI Number Information
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NPI Number | 1104009265
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Entity Type | Organization
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Legal Business Name | THE CENTER FOR PAIN AND SUPPORTIVE CARE P L L C
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Dates
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Enumeration Date | 12/12/2007
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 4611 E. SHEA BLVD. BLDG. 3 SUITE 190
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City | PHOENIX
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State | AZ
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Zip | 85028-4258
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Country | US
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Telephone | 480-889-0180
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Fax | 480-889-0186
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Provider Business Mailing Address
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Address Line | 4611 E. SHEA BLVD. BLDG. 3 SUITE 170
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City | PHOENIX
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State | AZ
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Zip | 85028-4258
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Country | US
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Telephone | 480-889-0180
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Fax | 480-889-0186
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Authorized Official
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Title or Position | MEMBER MANAGER
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Name | DR. GOBI PARAMANANDAM
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Credential |
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Telephone | 480-889-0180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Anesthesiology) Physician
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License Number | 24521
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 24521
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 24521
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | 24521
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License Number State | AZ
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