Provider Demographics
NPI:1497917660
Name:PAINCARE HEALTH INSTITUTE LLC
Entity Type:Organization
Organization Name:PAINCARE HEALTH INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:B
Authorized Official - Last Name:AUTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-433-0199
Mailing Address - Street 1:10815 W MCDOWELL RD
Mailing Address - Street 2:STE 304
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-5007
Mailing Address - Country:US
Mailing Address - Phone:623-433-0199
Mailing Address - Fax:623-433-0198
Practice Address - Street 1:10815 W MCDOWELL RD
Practice Address - Street 2:STE 304
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-5007
Practice Address - Country:US
Practice Address - Phone:623-433-0199
Practice Address - Fax:623-433-0198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ342563Medicaid
AZZ123474Medicare PIN