Phoenix Pain Treatment Centers, PLLC
Clinic/Center, Pain in Phoenix, AZ. Organization (NPI-2).
NPI number1982124582
StatusActive
Last updated in NPPESJul 21, 2022
Details
- NPI
- 1982124582
- Entity type
- Organization (NPI-2)
- Legal business name
- Phoenix Pain Treatment Centers, PLLC
- Organization subpart
- No
- Enumeration date
- Jun 23, 2017
- Certification date
- Dec 19, 2019
- Last updated
- Jul 21, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QP3300X | Clinic/Center, Pain | – | – | Yes |
| 208VP0014X | Pain Medicine, Interventional Pain Medicine | OTC8621 | AZ |
Practice location
9140 W Thomas Rd Ste B-106Phoenix, AZ 85037-3378
Phone 602-362-4747 · Fax 623-463-1111
Mailing address
9140 W Thomas Rd Ste B-106Phoenix, AZ 85037-3378
Phone 602-362-4747 · Fax 623-463-1111
Authorized official
Trever Jay Penny
Managing Member
6023624747
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