Basic Information
| Provider Information | |||||||||
| NPI: | 1013582279 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTEGRATED PAIN CONSULTANTS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9500 E IRONWOOD SQUARE DR STE 125 | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852584582 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6023777749 | ||||||||
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| Practice Location | |||||||||
| Address1: | 20045 N 19TH AVE STE 3 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850274265 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4806262552 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2021 | ||||||||
| LastUpdateDate: | 05/20/2021 | ||||||||
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| AuthorizedOfficialLastName: | RYAN | ||||||||
| AuthorizedOfficialFirstName: | MONICA | ||||||||
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| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 6023777749 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | COO | ||||||||
| NPICertificationDate: | 05/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.