Provider Demographics
NPI:1639660459
Name:THE PAIN CENTER OF ARIZONA, PC
Entity Type:Organization
Organization Name:THE PAIN CENTER OF ARIZONA, PC
Other - Org Name:GILBERT DME
Other - Org Type:Other Name
Authorized Official - Title/Position:VP, PATIENT SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDESTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-241-6101
Mailing Address - Street 1:5281 N 99TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85305-2209
Mailing Address - Country:US
Mailing Address - Phone:623-516-8252
Mailing Address - Fax:623-516-8253
Practice Address - Street 1:3645 S ROME ST STE 216
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-7338
Practice Address - Country:US
Practice Address - Phone:623-241-6152
Practice Address - Fax:623-516-8253
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE PAIN CENTER OF ARIZONA, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies