Provider Demographics
NPI:1194292730
Name:NORTH VALLEY PAIN CENTER PLLC
Entity type:Organization
Organization Name:NORTH VALLEY PAIN CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:BANGART
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:602-595-7228
Mailing Address - Street 1:7558 W THUNDERBIRD ROAD
Mailing Address - Street 2:STE 1 BOX 606
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-6080
Mailing Address - Country:US
Mailing Address - Phone:602-595-7228
Mailing Address - Fax:602-391-2770
Practice Address - Street 1:15650 N BLACK CANYON HWY # B121
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-4064
Practice Address - Country:US
Practice Address - Phone:602-595-7228
Practice Address - Fax:602-391-2770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical