Provider Demographics
NPI:1497153944
Name:PAIN CENTERS OF AMERICA, LLC
Entity Type:Organization
Organization Name:PAIN CENTERS OF AMERICA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:THEOFILIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:412-477-4493
Mailing Address - Street 1:9100 E RAINTREE DR
Mailing Address - Street 2:SUITE 248
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2762
Mailing Address - Country:US
Mailing Address - Phone:412-477-4493
Mailing Address - Fax:
Practice Address - Street 1:9100 EAST RAINTREE DRIVE
Practice Address - Street 2:SUITE 248
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260
Practice Address - Country:US
Practice Address - Phone:412-477-4493
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ006356207LP2900X
PAOS015718207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ915900Medicaid
AZ915900Medicaid