1366714628 NPI number — AMERICAN PAIN SOLUTIONS OF ARIZONA, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366714628 NPI number — AMERICAN PAIN SOLUTIONS OF ARIZONA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERICAN PAIN SOLUTIONS OF ARIZONA, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366714628
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4370 LA JOLLA VILLAGE DR
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92122-1249
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-769-2774
Provider Business Mailing Address Fax Number:
888-992-3532

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9023 E DESERT COVE DR
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85260-6714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-614-2774
Provider Business Practice Location Address Fax Number:
480-614-2773
Provider Enumeration Date:
02/02/2012

Additional Information

Authorized Official

Authorized Official Last Name:
HENSLEY
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
800-769-2774

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  1075866 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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