Provider Demographics
NPI:1588985394
Name:ARIZONA PAIN PHYSICIANS, LLC
Entity type:Organization
Organization Name:ARIZONA PAIN PHYSICIANS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:GOLLIHAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-486-1510
Mailing Address - Street 1:668 N 44TH ST
Mailing Address - Street 2:SUITE 100 W
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-6506
Mailing Address - Country:US
Mailing Address - Phone:602-840-3705
Mailing Address - Fax:623-486-1529
Practice Address - Street 1:668 N 44TH ST
Practice Address - Street 2:SUITE100-W
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-6506
Practice Address - Country:US
Practice Address - Phone:602-840-3705
Practice Address - Fax:623-486-1529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-15
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ139363OtherPTAN