Provider Demographics
NPI:1922580893
Name:PROFESSIONAL PHYSICIAN SERVICES LLC
Entity Type:Organization
Organization Name:PROFESSIONAL PHYSICIAN SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENTHORN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-861-4737
Mailing Address - Street 1:16824 N 53RD ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-1148
Mailing Address - Country:US
Mailing Address - Phone:480-861-4737
Mailing Address - Fax:
Practice Address - Street 1:4045 E BELL RD STE 147
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2239
Practice Address - Country:US
Practice Address - Phone:480-861-4737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty