MEDICARE: PAIN INSTITUTE OF SOUTHERN ARIZONA PISA 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		AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861575078
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAIN INSTITUTE OF SOUTHERN ARIZONA PISA PC

Provider Business Mailing Address
First Line	:	4881 E GRANT RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-2704
Country	:	US
Telephone Number	:	520-318-6035
Fax Number	:	520-795-9953

Provider Business Practice Location Address
First Line	:	4582 N FIRST AVE
Second Line	:	STE 170
City	:	TUCSON
State	:	AZ
Zip	:	85718-8607
Country	:	US
Telephone Number	:	520-318-6035
Fax Number	:	520-795-9953

Authorized Official
Title or Position	:	MANAGING EMPLOYEE
Name	:	JENNIFER L IRWIN
Credential	:
Telephone Number	:	520-318-6035

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	01/14/2026

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