Pinetop-Lakeside Integrative & Physical Medicine,LLC

Primary specialty

Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X

License

34673 Issued in AZ

Legal business name

PINETOP-LAKESIDE INTEGRATIVE & PHYSICAL MEDICINE,LLC

Practice address

1628 Reed LN
Lakeside, AZ 85929-6983

Phone

(928) 358-1648

Fax

(928) 368-5178

NPI assigned

Jun 13, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Kevin Mar, M.D.

Title

Manager

Phone

(928) 358-1648

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1276387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1276387200000",
    "number": "1376864462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1628 REED LN",
            "city": "LAKESIDE",
            "state": "AZ",
            "postal_code": "859296983",
            "telephone_number": "928-358-1648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1628 REED LN",
            "city": "LAKESIDE",
            "state": "AZ",
            "postal_code": "859296983",
            "telephone_number": "928-358-1648",
            "fax_number": "928-368-5178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINETOP-LAKESIDE INTEGRATIVE & PHYSICAL MEDICINE,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-13",
        "last_updated": "2010-06-13",
        "status": "A",
        "authorized_official_last_name": "MAR",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "928-358-1648",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "AZ",
            "license": "34673",
            "primary": false
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "AZ",
            "license": "34673",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peace Family Medicine PC
• Peak Physical Therapy, PLLC
• Pediatric Multicare West, LLC
• Pinetop Primary Palliative Care PLLC
• Pinetop Senior Living LLC
• Premier Mountain Imaging Center
• Michael Joseph Puchowicz, M.D.
• Jeffrey Maurice Reagan, M.D.
• Lorna Rae Reisner, NP
• Brent Riepel Sr., RPH

• Pain Medicine (Physical Medicine & Rehabilitation) Physician in Lakeside, AZ
• Providers in Lakeside, AZ by specialty
• Pain Medicine (Physical Medicine & Rehabilitation) Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2010; 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.