Provider Demographics
NPI:1053667923
Name:MCDOWELL MOUNTAIN PAIN MANAGEMENT CENTER, LLC
Entity Type:Organization
Organization Name:MCDOWELL MOUNTAIN PAIN MANAGEMENT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:R
Authorized Official - Last Name:PERRON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-767-1200
Mailing Address - Street 1:14700 N FRANK LLOYD WRIGHT BLVD
Mailing Address - Street 2:STE. 155
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2046
Mailing Address - Country:US
Mailing Address - Phone:480-767-1200
Mailing Address - Fax:
Practice Address - Street 1:10115 E BELL RD STE 101
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2189
Practice Address - Country:US
Practice Address - Phone:480-767-1200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-30
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7889261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain