Provider Demographics
NPI:1104009265
Name:THE CENTER FOR PAIN AND SUPPORTIVE CARE P L L C
Entity Type:Organization
Organization Name:THE CENTER FOR PAIN AND SUPPORTIVE CARE P L L C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:GOBI
Authorized Official - Middle Name:
Authorized Official - Last Name:PARAMANANDAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-889-0180
Mailing Address - Street 1:4611 E. SHEA BLVD. BLDG. 3
Mailing Address - Street 2:SUITE 170
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-4258
Mailing Address - Country:US
Mailing Address - Phone:480-889-0180
Mailing Address - Fax:480-889-0186
Practice Address - Street 1:4611 E. SHEA BLVD. BLDG. 3
Practice Address - Street 2:SUITE 190
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-4258
Practice Address - Country:US
Practice Address - Phone:480-889-0180
Practice Address - Fax:480-889-0186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24521207LH0002X, 207LP2900X, 208VP0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No207LH0002XAllopathic & Osteopathic PhysiciansAnesthesiologyHospice and Palliative MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ518589Medicaid
AZ518589Medicaid