Integrated Pain and Spine Otc ,LLC

Primary specialty

Pain Clinic/CenterTaxonomy code 261QP3300X

Legal business name

INTEGRATED PAIN AND SPINE OTC ,LLC

Practice address

13203 N 103Rd Ave Ste H5
Sun City, AZ 85351-3032

Phone

(623) 777-4747

NPI assigned

Sep 26, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Clifford Baker, MD

Title

MD/Owner

Phone

(623) 777-4747

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1506384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1255840914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13203 N 103RD AVE STE H5",
            "city": "SUN CITY",
            "state": "AZ",
            "postal_code": "853513032",
            "telephone_number": "623-777-4747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13203 N 103RD AVE STE H5",
            "city": "SUN CITY",
            "state": "AZ",
            "postal_code": "853513032",
            "telephone_number": "623-777-4747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED PAIN AND SPINE OTC ,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-26",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "BAKER",
        "authorized_official_first_name": "CLIFFORD",
        "authorized_official_title_or_position": "MD/OWNER",
        "authorized_official_telephone_number": "623-777-4747",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1235342775",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.