Provider Demographics
NPI:1497243794
Name:TEMPE INTERVENTIONAL TREATMENT CENTER LLC
Entity Type:Organization
Organization Name:TEMPE INTERVENTIONAL TREATMENT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:VIGNEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-887-3300
Mailing Address - Street 1:1001 E WARNER RD STE 103
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-3224
Mailing Address - Country:US
Mailing Address - Phone:480-887-3300
Mailing Address - Fax:480-887-3312
Practice Address - Street 1:1001 E WARNER RD STE 107
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284
Practice Address - Country:US
Practice Address - Phone:480-887-3300
Practice Address - Fax:480-887-3312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-23
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical