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General NPI Number Information
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NPI Number | 1750873287
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Entity Type | Organization
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Legal Business Name | THE PAIN CENTER OF ARIZONA, PC
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Dates
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Enumeration Date | 05/31/2018
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Last Update Date | 05/31/2018
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Provider Practice Location Address
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Address Line | 13967 W GRAND AVE STE 103
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City | SURPRISE
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State | AZ
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Zip | 85374-3732
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Country | US
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Telephone | 623-516-8252
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Fax | 623-516-8253
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Provider Business Mailing Address
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Address Line | 5281 N 99TH AVE STE 100
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City | GLENDALE
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State | AZ
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Zip | 85305-2209
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Country | US
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Telephone | 623-516-8252
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Fax | 623-516-8253
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Authorized Official
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Title or Position | VP, PATIENT SERVICES
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Name | CATHY HARDESTY
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Credential |
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Telephone | 623-241-6101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State | AZ
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