MEDICARE: SOUTHWEST PAIN CONSULTANTS 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	207LP2900X	Pain Medicine (Anesthesiology) Physician

General Provider Information

NPI Number	:	1790221323
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST PAIN CONSULTANTS PLLC

Provider Business Mailing Address
First Line	:	2303 N 44TH ST
Second Line	:	STE. 14-1472
City	:	PHOENIX
State	:	AZ
Zip	:	85008-2442
Country	:	US
Telephone Number	:	602-710-1017
Fax Number	:

Provider Business Practice Location Address
First Line	:	2303 N 44TH ST
Second Line	:	STE. 14-1472
City	:	PHOENIX
State	:	AZ
Zip	:	85008-2442
Country	:	US
Telephone Number	:	602-710-1017
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	TOURE ALI KNIGHTON
Credential	:	M.D.
Telephone Number	:	602-710-1017

Provider Enumeration Date	:	01/06/2017
Last Update Date	:	01/06/2017

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