Provider Demographics
NPI:1104449628
Name:THE PAIN INSTITUTE OF SOUTHERN ARIZONA PISA PC
Entity type:Organization
Organization Name:THE PAIN INSTITUTE OF SOUTHERN ARIZONA PISA PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-829-6776
Mailing Address - Street 1:4881 E GRANT ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2704
Mailing Address - Country:US
Mailing Address - Phone:520-318-6035
Mailing Address - Fax:520-829-6661
Practice Address - Street 1:2241 W 16TH STREET
Practice Address - Street 2:
Practice Address - City:SAFFORD
Practice Address - State:AZ
Practice Address - Zip Code:85546
Practice Address - Country:US
Practice Address - Phone:520-829-6900
Practice Address - Fax:520-829-6661
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAIN INSTITUTE OF SOUTHERN ARIZONA PISA PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-05-19
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ954926Medicaid
AZ526906Medicaid