1770197873 NPI number — CAMELBACK PAIN CENTER PLLC

Table of content: (NPI 1770197873)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770197873 NPI number — CAMELBACK PAIN CENTER PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAMELBACK PAIN CENTER PLLC
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:
1770197873
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4400 N SCOTTSDALE RD STE 9-332
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85251-3331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-572-2444
Provider Business Mailing Address Fax Number:
602-581-7158

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5410 N SCOTTSDALE RD STE B200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARADISE VALLEY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85253-5910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-572-2444
Provider Business Practice Location Address Fax Number:
602-581-7158
Provider Enumeration Date:
09/04/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VARTEVAN
Authorized Official First Name:
NORVAN
Authorized Official Middle Name:
K
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
214-893-1069

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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