MEDICARE: TUCSON INTERVENTIONAL PAIN MANAGEMENT PC

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	207LP2900X	Pain Medicine (Anesthesiology) Physician

General Provider Information

NPI Number	:	1134331325
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TUCSON INTERVENTIONAL PAIN MANAGEMENT PC

Provider Business Mailing Address
First Line	:	PO BOX 32216
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85751-2216
Country	:	US
Telephone Number	:	520-299-8200
Fax Number	:	520-299-8202

Provider Business Practice Location Address
First Line	:	5300 E ERICKSON DR
Second Line	:	SUITE 116
City	:	TUCSON
State	:	AZ
Zip	:	85712-2828
Country	:	US
Telephone Number	:	520-299-8200
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ROBERT J. BERENS
Credential	:	MD
Telephone Number	:	602-273-6770

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	12/12/2018

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