1366714628 NPI number — AMERICAN PAIN SOLUTIONS OF ARIZONA, LLC

Table of content: (NPI 1366714628)

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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