Provider Demographics
NPI:1255979332
Name:PHOENIX PAIN TREATMENT CENTERS, PLLC
Entity type:Organization
Organization Name:PHOENIX PAIN TREATMENT CENTERS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:
Authorized Official - Last Name:PENNY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-395-0718
Mailing Address - Street 1:PO BOX 39179
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85069-9179
Mailing Address - Country:US
Mailing Address - Phone:602-643-7964
Mailing Address - Fax:
Practice Address - Street 1:9140 W THOMAS RD STE B-106
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-3378
Practice Address - Country:US
Practice Address - Phone:602-395-0718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain