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General NPI Number Information
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NPI Number | 1104449628
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Entity Type | Organization
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Legal Business Name | THE PAIN INSTITUTE OF SOUTHERN ARIZONA PISA PC
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Dates
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Enumeration Date | 05/19/2020
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Last Update Date | 01/28/2021
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Provider Practice Location Address
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Address Line | 2241 W 16TH STREET
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City | SAFFORD
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State | AZ
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Zip | 85546
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Country | US
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Telephone | 520-829-6900
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Fax | 520-829-6661
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Provider Business Mailing Address
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Address Line | 4881 E GRANT ROAD SUITE 101
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City | TUCSON
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State | AZ
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Zip | 85712-2704
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Country | US
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Telephone | 520-318-6035
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Fax | 520-829-6661
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Authorized Official
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Title or Position | CEO
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Name | JOHN H COLE
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Credential |
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Telephone | 520-829-6776
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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