Provider Demographics
NPI:1861689986
Name:PAINCARE OF ARIZONA, LLC
Entity Type:Organization
Organization Name:PAINCARE OF ARIZONA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SKY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-332-2338
Mailing Address - Street 1:10815 W MCDOWELL RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-5007
Mailing Address - Country:US
Mailing Address - Phone:623-433-0199
Mailing Address - Fax:623-433-0198
Practice Address - Street 1:10815 W MCDOWELL RD
Practice Address - Street 2:SUITE 304
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-5007
Practice Address - Country:US
Practice Address - Phone:623-433-0199
Practice Address - Fax:623-433-0198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC4249261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty