East Valley Spine and Sports Medicine Center, PLC

Primary specialty

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

License

33084 Issued in AZ

Legal business name

EAST VALLEY SPINE AND SPORTS MEDICINE CENTER, PLC

Practice address

4858 E Baseline Rd
Suite 107
Mesa, AZ 85206-4638

Phone

(480) 807-6500

Fax

(866) 835-7591

NPI assigned

Mar 8, 2007

Last updated

Jun 16, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Tutankhamen Allotey Pappoe, M.D.

Title

Owner and Physician

Phone

(480) 807-6500

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Tutankhamen Pappoe MD PLC Former legal business name

Locations

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

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1434412800000",
    "number": "1659402998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4858 E BASELINE RD STE 107",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852064638",
            "telephone_number": "480-807-6500",
            "fax_number": "866-835-7591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4858 E BASELINE RD",
            "address_2": "SUITE 107",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852064638",
            "telephone_number": "480-807-6500",
            "fax_number": "866-835-7591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST VALLEY SPINE AND SPORTS MEDICINE CENTER, PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-08",
        "last_updated": "2015-06-16",
        "status": "A",
        "authorized_official_last_name": "PAPPOE",
        "authorized_official_first_name": "TUTANKHAMEN",
        "authorized_official_middle_name": "ALLOTEY",
        "authorized_official_title_or_position": "OWNER AND PHYSICIAN",
        "authorized_official_telephone_number": "480-807-6500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2081P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "AZ",
            "license": "33084",
            "primary": true
        },
        {
            "code": "2081S0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": "AZ",
            "license": "33084",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "873671",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tutankhamen Pappoe MD PLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Pain Medicine (Physical Medicine & Rehabilitation) Physician in Mesa, AZ
• Providers in Mesa, 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 16, 2015; 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.