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NPI Code Detail

MEDICARE: PRIME MEDICAL PAIN MANAGEMENT CENTER

MEDICARE: PRIME MEDICAL PAIN MANAGEMENT CENTER
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
1261QP3300XPain Clinic/Center

General Provider Information

NPI Number : 1487022323
Entity Type Code : Organization
Provider Name (Legal Business Name) : PRIME MEDICAL PAIN MANAGEMENT CENTER
Provider Business Mailing Address
First Line : 4527 N 27TH AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85017-3702
Country : US
Telephone Number : 602-300-4754
Fax Number : 602-249-1614
Provider Business Practice Location Address
First Line : 4527 N 27TH AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85017-3702
Country : US
Telephone Number : 602-300-4754
Fax Number : 602-249-1614
Authorized Official
Title or Position : OWNER
Name : ROGER BAKER
Credential : DC
Telephone Number : 602-300-4754
Provider Enumeration Date : 09/09/2015
Last Update Date : 09/09/2015

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Directions to “PRIME MEDICAL PAIN MANAGEMENT CENTER ” Practice Location

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