Provider Demographics
NPI:1811378631
Name:PAIN TREATMENT CENTER OF TEMPE
Entity Type:Organization
Organization Name:PAIN TREATMENT CENTER OF TEMPE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BURROLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-820-5603
Mailing Address - Street 1:4515 S. MCCLINTOCK DRIVE
Mailing Address - Street 2:SUITE 114
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282
Mailing Address - Country:US
Mailing Address - Phone:480-820-5603
Mailing Address - Fax:480-323-2323
Practice Address - Street 1:4515 S. MCCLINTOCK DRIVE
Practice Address - Street 2:SUITE 114
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282
Practice Address - Country:US
Practice Address - Phone:480-820-5603
Practice Address - Fax:480-323-2323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-17
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical