Provider Demographics
NPI:1194009225
Name:ADVANCED PAIN CLINIC LLC
Entity Type:Organization
Organization Name:ADVANCED PAIN CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-248-6160
Mailing Address - Street 1:33747 N SCOTTSDALE RD
Mailing Address - Street 2:SUITE 135
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85266-1565
Mailing Address - Country:US
Mailing Address - Phone:480-248-6160
Mailing Address - Fax:480-284-4180
Practice Address - Street 1:33747 N SCOTTSDALE RD
Practice Address - Street 2:SUITE 135
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85266-1565
Practice Address - Country:US
Practice Address - Phone:480-248-6160
Practice Address - Fax:480-284-4180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-07
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ148880Medicare PIN
AZZ148881Medicare UPIN