Provider Demographics
NPI:1932565942
Name:URGENT PAIN, LLC
Entity Type:Organization
Organization Name:URGENT PAIN, LLC
Other - Org Name:PAIN MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-612-7480
Mailing Address - Street 1:7301 E. 2ND ST.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-5610
Mailing Address - Country:US
Mailing Address - Phone:480-994-5977
Mailing Address - Fax:480-990-9397
Practice Address - Street 1:6025 N. 27TH AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85017
Practice Address - Country:US
Practice Address - Phone:602-428-8888
Practice Address - Fax:602-566-8149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-06
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ124152Medicaid