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General NPI Number Information
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NPI Number | 1366803884
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Entity Type | Organization
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Legal Business Name | INTERGRATIVE PAIN CENTER OF ARIZONA
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Dates
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Enumeration Date | 03/10/2016
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Last Update Date | 03/10/2016
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Provider Practice Location Address
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Address Line | 3945 E PARADISE FALLS DR STE 105
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City | TUCSON
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State | AZ
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Zip | 85712-6686
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Country | US
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Telephone | 520-797-7246
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Fax | 520-795-4249
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Provider Business Mailing Address
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Address Line | 3945 E PARADISE FALLS DR STE 105
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City | TUCSON
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State | AZ
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Zip | 85712-6686
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Country | US
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Telephone | 520-797-7246
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Fax | 520-795-4249
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | KIM LOOMAN
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Credential |
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Telephone | 520-797-7246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 193200000X
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License Number State | AZ
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