Provider Demographics
NPI:1154868495
Name:PLATINUM PAIN MANAGEMENT
Entity Type:Organization
Organization Name:PLATINUM PAIN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSHIRI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-322-0980
Mailing Address - Street 1:10810 N TATUM BLVD
Mailing Address - Street 2:STE 102-302
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-6055
Mailing Address - Country:US
Mailing Address - Phone:424-322-0980
Mailing Address - Fax:
Practice Address - Street 1:4045 E BELL RD STE 147
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2239
Practice Address - Country:US
Practice Address - Phone:602-795-0207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-25
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ348252084N0400X, 208VP0014X
2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty