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General NPI Number Information
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NPI Number | 1104957869
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Entity Type | Organization
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Legal Business Name | PAIN SOLUTIONS CENTER, LLC
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 03/09/2011
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Provider Practice Location Address
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Address Line | 15262 N 75TH AVE SUITE 400
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City | PEORIA
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State | AZ
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Zip | 85381-4763
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Country | US
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Telephone | 623-486-1510
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Fax | 623-486-1529
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Provider Business Mailing Address
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Address Line | 15262 N 75TH AVE SUITE 400
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City | PEORIA
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State | AZ
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Zip | 85381-4763
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Country | US
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Telephone | 623-486-1510
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Fax | 623-486-1529
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Authorized Official
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Title or Position | MANAGER
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Name | MS. CINDY D GOLLIHAR
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Credential |
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Telephone | 623-486-1510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | OTC4813
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License Number State | AZ
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