Provider Demographics
NPI:1821565474
Name:PD AMBULATORY PAIN TREATMENT CENTER, LLC
Entity Type:Organization
Organization Name:PD AMBULATORY PAIN TREATMENT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LERNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-245-6151
Mailing Address - Street 1:9977 N 90TH ST STE 350
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4434
Mailing Address - Country:US
Mailing Address - Phone:480-207-1835
Mailing Address - Fax:480-245-6197
Practice Address - Street 1:1301 E MCDOWELL RD STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2605
Practice Address - Country:US
Practice Address - Phone:480-207-1835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain