Provider Demographics
NPI:1508033812
Name:ADVANCED PAIN MEDICINE OF SOUTHERN ARIZONA PC
Entity Type:Organization
Organization Name:ADVANCED PAIN MEDICINE OF SOUTHERN ARIZONA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:CHASE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-205-2249
Mailing Address - Street 1:1521 E TANGERINE RD
Mailing Address - Street 2:SUITE 161
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85755
Mailing Address - Country:US
Mailing Address - Phone:520-205-2249
Mailing Address - Fax:520-382-1424
Practice Address - Street 1:1521 E TANGERINE RD
Practice Address - Street 2:SUITE 161
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85755
Practice Address - Country:US
Practice Address - Phone:520-205-2249
Practice Address - Fax:520-382-1424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI2134195Medicaid
WIG34924Medicare UPIN
WI000260205Medicare PIN