Provider Demographics
NPI:1356615074
Name:PHOENIX PAIN CLINIC, PLLC
Entity type:Organization
Organization Name:PHOENIX PAIN CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SALVATORE
Authorized Official - Middle Name:R
Authorized Official - Last Name:CAMPO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:214-324-9400
Mailing Address - Street 1:1110 N BUCKNER BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-3498
Mailing Address - Country:US
Mailing Address - Phone:214-324-9400
Mailing Address - Fax:214-324-9402
Practice Address - Street 1:1110 N BUCKNER BLVD STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-3498
Practice Address - Country:US
Practice Address - Phone:214-324-9400
Practice Address - Fax:214-324-9402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-27
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty