=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558858712
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNION HILLS PAIN PARTNERS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/13/2018
-----------------------------------------------------
Last Update Date | 04/13/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4727 E UNION HILLS DR STE 300
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85050-3387
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-207-3737
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 223970
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15251-2970
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-207-3716
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SVP ASC OPERATIONS AND BUSINESS SER
-----------------------------------------------------
Name | BRIAN GIESSLER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 480-207-3716
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------