MEDICARE: TOMAR PAIN CENTERS, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208VP0014X	Interventional Pain Medicine Physician
2	261QA1903X	Ambulatory Surgical Clinic/Center	OTC4761	AZ

General Provider Information

NPI Number	:	1063735793
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOMAR PAIN CENTERS, PLLC

Provider Business Mailing Address
First Line	:	1821 N TREKELL RD STE 3B
Second Line	:
City	:	CASA GRANDE
State	:	AZ
Zip	:	85122-1705
Country	:	US
Telephone Number	:	520-876-0528
Fax Number	:	520-421-2009

Provider Business Practice Location Address
First Line	:	1821 N TREKELL RD STE 3B
Second Line	:
City	:	CASA GRANDE
State	:	AZ
Zip	:	85122-1705
Country	:	US
Telephone Number	:	520-876-0528
Fax Number	:	520-421-2009

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	JESSICA HANEY
Credential	:
Telephone Number	:	520-421-0986

Provider Enumeration Date	:	03/09/2010
Last Update Date	:	01/17/2020

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