Provider Demographics
NPI:1447417928
Name:INTEGRATED INTERVENTIONAL PAIN MANAGEMENT P.C.
Entity Type:Organization
Organization Name:INTEGRATED INTERVENTIONAL PAIN MANAGEMENT P.C.
Other - Org Name:THE BETH-EL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KLEE
Authorized Official - Middle Name:S
Authorized Official - Last Name:BETHEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-502-8724
Mailing Address - Street 1:PO BOX 3490
Mailing Address - Street 2:
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85117-4126
Mailing Address - Country:US
Mailing Address - Phone:602-502-8724
Mailing Address - Fax:480-545-2788
Practice Address - Street 1:2152 E BROADWAY RD
Practice Address - Street 2:SUITE 1
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1751
Practice Address - Country:US
Practice Address - Phone:480-892-5313
Practice Address - Fax:480-545-2788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ18441208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZDN6336OtherRAILROAD MEDICARE
AZ339942Medicaid
AZDN6336OtherRAILROAD MEDICARE
AZ6344350001Medicare NSC