Provider Demographics
NPI:1992118673
Name:REGIONAL PAIN INSTITUTE, LLC
Entity type:Organization
Organization Name:REGIONAL PAIN INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:602-694-8546
Mailing Address - Street 1:36453 N GANTZEL RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-7340
Mailing Address - Country:US
Mailing Address - Phone:480-636-1225
Mailing Address - Fax:480-636-8890
Practice Address - Street 1:36453 N GANTZEL RD STE 101
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85140-7340
Practice Address - Country:US
Practice Address - Phone:480-636-1225
Practice Address - Fax:480-636-8890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-10
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty