Provider Demographics
NPI:1053366989
Name:PAIN CENTERS NATIONWIDE, PC
Entity type:Organization
Organization Name:PAIN CENTERS NATIONWIDE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:PANNOZZO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-776-8686
Mailing Address - Street 1:8877 W UNION HILLS DR
Mailing Address - Street 2:200
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-3008
Mailing Address - Country:US
Mailing Address - Phone:623-776-8686
Mailing Address - Fax:623-776-8687
Practice Address - Street 1:8877 W UNION HILLS DR STE 200
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-3016
Practice Address - Country:US
Practice Address - Phone:623-776-8686
Practice Address - Fax:623-776-8687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31052208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z85110Medicare PIN