MEDICARE: SANTOS INTERVENTIONAL PAIN MEDICINE, P.C.

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	44282	AZ

General Provider Information

NPI Number	:	1164702197
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANTOS INTERVENTIONAL PAIN MEDICINE, P.C.

Provider Business Mailing Address
First Line	:	PO BOX 33309
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-3309
Country	:	US
Telephone Number	:	702-434-7246
Fax Number	:	702-258-5581

Provider Business Practice Location Address
First Line	:	2501 STOCKTON HILL RD
Second Line	:	SUITE 106
City	:	KINGMAN
State	:	AZ
Zip	:	86401-4140
Country	:	US
Telephone Number	:	928-718-7210
Fax Number	:	928-718-7216

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CRISPINO SANTOS SANTOS
Credential	:	M.D.
Telephone Number	:	702-434-7246

Provider Enumeration Date	:	08/22/2011
Last Update Date	:	08/22/2011

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