Provider Demographics
NPI:1720659048
Name:RED BUTTE HEALTHCARE
Entity Type:Organization
Organization Name:RED BUTTE HEALTHCARE
Other - Org Name:RED BUTTE PAIN SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KARL
Authorized Official - Middle Name:
Authorized Official - Last Name:HURST-WICKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-633-4334
Mailing Address - Street 1:5590 W CHANDLER BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-3744
Mailing Address - Country:US
Mailing Address - Phone:602-633-4334
Mailing Address - Fax:
Practice Address - Street 1:5590 W CHANDLER BLVD STE 3
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-3744
Practice Address - Country:US
Practice Address - Phone:602-633-4334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-07
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty