Provider Demographics
NPI:1417255621
Name:CAREFREE PAIN CLINIC LLC
Entity Type:Organization
Organization Name:CAREFREE PAIN CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JURGEN
Authorized Official - Middle Name:
Authorized Official - Last Name:OLTJENBRUNS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-488-1282
Mailing Address - Street 1:PO BOX 232
Mailing Address - Street 2:
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85327-0232
Mailing Address - Country:US
Mailing Address - Phone:480-488-1282
Mailing Address - Fax:480-488-9040
Practice Address - Street 1:7208 E. CAVE CREEK RD.
Practice Address - Street 2:SUITE F
Practice Address - City:CAREFREE
Practice Address - State:AZ
Practice Address - Zip Code:85377
Practice Address - Country:US
Practice Address - Phone:480-488-1282
Practice Address - Fax:480-488-9040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC4954261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical