Provider Demographics
NPI:1114477791
Name:UPTOWN PAINSTOP, LLC
Entity Type:Organization
Organization Name:UPTOWN PAINSTOP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WAYCHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-331-4222
Mailing Address - Street 1:3724 N 3RD ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2034
Mailing Address - Country:US
Mailing Address - Phone:480-331-4222
Mailing Address - Fax:480-471-6315
Practice Address - Street 1:3724 N 3RD ST
Practice Address - Street 2:SUITE 300
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2034
Practice Address - Country:US
Practice Address - Phone:480-331-4222
Practice Address - Fax:480-471-6315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-07
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty