Provider Demographics
NPI:1952655110
Name:PMC PAIN MANAGEMENT CENTER PLLC
Entity Type:Organization
Organization Name:PMC PAIN MANAGEMENT CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-703-7276
Mailing Address - Street 1:8914 N.91 AVE
Mailing Address - Street 2:SUITE 100B
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85260
Mailing Address - Country:US
Mailing Address - Phone:623-877-0100
Mailing Address - Fax:623-328-7386
Practice Address - Street 1:8914 N.91 AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345
Practice Address - Country:US
Practice Address - Phone:623-877-0100
Practice Address - Fax:623-328-7386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-08
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain