Provider Demographics
NPI:1871846055
Name:AZ PAIN SPECIALISTS, LLC
Entity Type:Organization
Organization Name:AZ PAIN SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:MRS
Authorized Official - First Name:VENUS
Authorized Official - Middle Name:LORRAINE
Authorized Official - Last Name:GAINES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:623-486-1510
Mailing Address - Street 1:14100 N 83RD AVE
Mailing Address - Street 2:SUITE 260
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-5658
Mailing Address - Country:US
Mailing Address - Phone:623-486-1510
Mailing Address - Fax:623-486-1529
Practice Address - Street 1:668 N 44TH ST
Practice Address - Street 2:SUITE 100-W
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-6506
Practice Address - Country:US
Practice Address - Phone:623-486-1510
Practice Address - Fax:623-486-1529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-24
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty