Provider Demographics
NPI:1134331325
Name:TUCSON INTERVENTIONAL PAIN MANAGEMENT PC
Entity type:Organization
Organization Name:TUCSON INTERVENTIONAL PAIN MANAGEMENT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:BERENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-273-6770
Mailing Address - Street 1:PO BOX 32216
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85751-2216
Mailing Address - Country:US
Mailing Address - Phone:520-299-8200
Mailing Address - Fax:520-299-8202
Practice Address - Street 1:5300 E ERICKSON DR
Practice Address - Street 2:SUITE 116
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2828
Practice Address - Country:US
Practice Address - Phone:520-299-8200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZE47385Medicare UPIN
AZZ81140Medicare PIN