Provider Demographics
NPI:1093043457
Name:TUCSON PAIN PHYSICIANS, LLC
Entity Type:Organization
Organization Name:TUCSON PAIN PHYSICIANS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:GOLLIHAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-486-1510
Mailing Address - Street 1:14100 N 83RD AVE
Mailing Address - Street 2:SUITE 260
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-5658
Mailing Address - Country:US
Mailing Address - Phone:623-486-1510
Mailing Address - Fax:623-486-1529
Practice Address - Street 1:6080 N LA CHOLLA BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3555
Practice Address - Country:US
Practice Address - Phone:520-292-2723
Practice Address - Fax:623-486-1529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-24
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ142913OtherPTAN