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General NPI Number Information
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NPI Number | 1114196383
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Entity Type | Organization
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Legal Business Name | PHOENIX PAIN TREATMENT CENTER
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Dates
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Enumeration Date | 02/21/2008
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Last Update Date | 02/21/2008
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Provider Practice Location Address
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Address Line | 3124 E ROOSEVELT ST # D-2
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City | PHOENIX
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State | AZ
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Zip | 85008-5088
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Country | US
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Telephone | 602-244-9200
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Fax | 602-244-9222
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Provider Business Mailing Address
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Address Line | 3124 E ROOSEVELT ST # D-2
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City | PHOENIX
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State | AZ
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Zip | 85008-5088
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Country | US
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Telephone | 602-244-9200
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Fax | 602-244-9222
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. WILLIAM MURRAY SMITH SR.
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Credential | M.D.
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Telephone | 602-244-9200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC-10133
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License Number State | AZ
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