Provider Demographics
NPI:1902077100
Name:CENTER FOR PAIN TREATMENT INC
Entity Type:Organization
Organization Name:CENTER FOR PAIN TREATMENT INC
Other - Org Name:DAVIS MEDICAL CENTER/DAVIS FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:E
Authorized Official - Last Name:QUINTERO
Authorized Official - Suffix:
Authorized Official - Credentials:VICE PRESIDENT
Authorized Official - Phone:928-634-5118
Mailing Address - Street 1:55 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-4237
Mailing Address - Country:US
Mailing Address - Phone:928-634-5118
Mailing Address - Fax:928-634-8522
Practice Address - Street 1:55 S 6TH ST
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4237
Practice Address - Country:US
Practice Address - Phone:928-634-5118
Practice Address - Fax:928-634-8522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4555208D00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty