Provider Demographics
NPI:1306404454
Name:PAINX JOINT- REVITALIZATION INC
Entity Type:Organization
Organization Name:PAINX JOINT- REVITALIZATION INC
Other - Org Name:PAINX
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:AMAYA
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:602-828-6705
Mailing Address - Street 1:62 N STAPLEY DR STE B
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-8845
Mailing Address - Country:US
Mailing Address - Phone:602-828-6705
Mailing Address - Fax:
Practice Address - Street 1:62 N STAPLEY DR STE B
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-8845
Practice Address - Country:US
Practice Address - Phone:602-828-6705
Practice Address - Fax:602-581-7160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-04
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty