Provider Demographics
NPI:1316192602
Name:ARIZONA PAIN SPECIALISTS, PLLC
Entity Type:Organization
Organization Name:ARIZONA PAIN SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-563-6400
Mailing Address - Street 1:PO BOX 6408
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85261-6408
Mailing Address - Country:US
Mailing Address - Phone:480-563-6400
Mailing Address - Fax:480-563-8009
Practice Address - Street 1:18555 N 79TH AVE
Practice Address - Street 2:SUITE E101
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8370
Practice Address - Country:US
Practice Address - Phone:623-878-7246
Practice Address - Fax:623-878-7245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-01
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ41788207L00000X
AZ36803207LP2900X
AZ35497207LP2900X
261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ399751Medicaid