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General NPI Number Information
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NPI Number | 1538429121
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Entity Type | Organization
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Legal Business Name | SR BILLING
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Dates
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Enumeration Date | 05/17/2012
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Last Update Date | 05/17/2012
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Provider Practice Location Address
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Address Line | 12361 W BOLA DR SUITE 109
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City | SURPRISE
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State | AZ
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Zip | 85378
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Country | US
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Telephone | 623-974-9571
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Fax |
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Provider Business Mailing Address
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Address Line | 12361 W BOLA DR SUITE 109
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City | SURPRISE
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State | AZ
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Zip | 85378
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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
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Name | DR. BO E MCCLAIN
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Credential | MD
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Telephone | 623-974-9571
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State | AZ
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