Provider Demographics
NPI:1548497159
Name:PREFERRED PAIN CENTER, LLC
Entity type:Organization
Organization Name:PREFERRED PAIN CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:BELT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-507-6550
Mailing Address - Street 1:PO BOX 29661
Mailing Address - Street 2:DEPT. # 2056
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85038-9661
Mailing Address - Country:US
Mailing Address - Phone:602-507-6550
Mailing Address - Fax:602-759-1741
Practice Address - Street 1:10255 N 32ND ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3851
Practice Address - Country:US
Practice Address - Phone:602-507-6550
Practice Address - Fax:602-759-1741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-22
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZOTC4724OtherOTC LICENSE