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General NPI Number Information
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NPI Number | 1437795598
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Entity Type | Organization
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Legal Business Name | PAIN SPECIALTY SURGICAL CENTER
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Dates
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Enumeration Date | 11/25/2019
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Last Update Date | 04/27/2020
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Provider Practice Location Address
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Address Line | 3303 E BASELINE RD STE 104
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City | GILBERT
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State | AZ
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Zip | 85234-2739
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Country | US
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Telephone | 480-550-9393
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Fax |
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Provider Business Mailing Address
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Address Line | 3370 S MERCY RD STE 321
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City | GILBERT
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State | AZ
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Zip | 85297-0417
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/MEDICAL DIRECTOR
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Name | DR. AHDEV KUPPUSAMY
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Credential | MD
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Telephone | 480-550-9393
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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 |
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License Number State |
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