Provider Demographics
NPI:1649407180
Name:PAIN MDS INC
Entity Type:Organization
Organization Name:PAIN MDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:PANNOZZO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-776-8686
Mailing Address - Street 1:2525 W CAREFREE HWY
Mailing Address - Street 2:SUITE 134, BUILDING 5
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-6093
Mailing Address - Country:US
Mailing Address - Phone:623-580-4357
Mailing Address - Fax:
Practice Address - Street 1:2525 W CAREFREE HWY STE 134
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085
Practice Address - Country:US
Practice Address - Phone:623-580-4357
Practice Address - Fax:623-580-5249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-11
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ207LP2900X, 208VP0014X, 261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ670929Medicaid
AZZ136388Medicare PIN