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General NPI Number Information
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NPI Number | 1497326615
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Entity Type | Organization
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Legal Business Name | AZ PAIN MEDICINE CLINIC, LLC.
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Dates
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Enumeration Date | 07/08/2021
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Last Update Date | 07/08/2021
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Provider Practice Location Address
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Address Line | 8805 N 23RD AVE STE 160
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City | PHOENIX
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State | AZ
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Zip | 85021-4116
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Country | US
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Telephone | 602-368-8800
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Fax | 602-368-8801
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Provider Business Mailing Address
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Address Line | 8805 N 23RD AVE STE 160
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City | PHOENIX
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State | AZ
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Zip | 85021-4116
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Country | US
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Telephone | 602-368-8800
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Fax | 602-368-8801
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JASON MOORE
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Credential |
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Telephone | 602-368-8800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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