Provider Demographics
NPI:1437234465
Name:PAIN CONSULTANTS OF ARIZONA, PC
Entity type:Organization
Organization Name:PAIN CONSULTANTS OF ARIZONA, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DO
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:KUBITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-222-7246
Mailing Address - Street 1:20950 N TATUM BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-4200
Mailing Address - Country:US
Mailing Address - Phone:480-222-7246
Mailing Address - Fax:602-322-1684
Practice Address - Street 1:20950 N TATUM BLVD STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-4204
Practice Address - Country:US
Practice Address - Phone:480-222-7246
Practice Address - Fax:480-222-7271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28310207LP2900X, 208VP0014X
AZ4087208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0463800OtherPAUL'S BCBS #
AZAZ0743670OtherDR. RUBIN'S BCBS #
AZZ77463Medicare ID - Type UnspecifiedDR. RUBIN'S MEDICARE #
AZZ77461Medicare ID - Type UnspecifiedOFFICE MEDICARE GROUP #
AZAZ0463800OtherPAUL'S BCBS #
AZ103562Medicare ID - Type UnspecifiedPAUL'S MEDICARE #
AZ5149730001Medicare NSC