Provider Demographics
NPI:1154639813
Name:PREFERRED PAIN CENTER LAVEEN, LLC
Entity Type:Organization
Organization Name:PREFERRED PAIN CENTER LAVEEN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-507-6550
Mailing Address - Street 1:2813 E CAMELBACK RD
Mailing Address - Street 2:SUITE 430
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4325
Mailing Address - Country:US
Mailing Address - Phone:602-507-6550
Mailing Address - Fax:602-759-1741
Practice Address - Street 1:5045 W BASELINE RD
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-7392
Practice Address - Country:US
Practice Address - Phone:602-507-6550
Practice Address - Fax:602-759-1741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty