Basic Information
| Provider Information | |||||||||
| NPI: | 1538612965 | ||||||||
| 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: | 4806262552 | ||||||||
| FaxNumber: | 4806262551 | ||||||||
| Practice Location | |||||||||
| Address1: | 9500 E IRONWOOD SQUARE DR STE 125 | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852584582 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4806262552 | ||||||||
| FaxNumber: | 4806262551 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2016 | ||||||||
| LastUpdateDate: | 09/09/2022 | ||||||||
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| AuthorizedOfficialLastName: | MIRANDA | ||||||||
| AuthorizedOfficialFirstName: | ADRIAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR-CREDENTIALS & CONTRACTING | ||||||||
| AuthorizedOfficialTelephone: | 6025703169 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0014X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | 261QM1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
ID Information
| ID | Type | State | Issuer | Description | 183777 | 05 | AZ | MEDICAID |