Provider Demographics
NPI:1871650739
Name:THE PAIN CENTER OF ARIZONA, PC
Entity Type:Organization
Organization Name:THE PAIN CENTER OF ARIZONA, PC
Other - Org Name:THE PAIN CENTER OF ARIZONA
Other - Org Type:Other Name
Authorized Official - Title/Position:VP ADMIN OPERATIONS
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 1:20333 N 19TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-3602
Practice Address - Country:US
Practice Address - Phone:623-516-8252
Practice Address - Fax:623-516-8253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ71338Medicare UPIN
Z71338Medicare UPIN