Glendale Pain Treatment Center

Primary specialty

Pain Clinic/CenterTaxonomy code 261QP3300X

Legal business name

GLENDALE PAIN TREATMENT CENTER

Practice address

18301 N 79TH Ave Ste F168
Glendale, AZ 85308-6045

Phone

(602) 675-0478

Fax

(602) 675-0479

NPI assigned

Sep 15, 2020

Organization subpart

No

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

Authorized official

Name

Seth Clark, DPM

Title

Owner

Phone

(801) 448-4841

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1600128000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624320000000",
    "number": "1962017038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18301 N 79TH AVE STE F168",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853086045",
            "telephone_number": "602-675-0478",
            "fax_number": "602-675-0479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18301 N 79TH AVE STE F168",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853086045",
            "telephone_number": "602-675-0478",
            "fax_number": "602-675-0479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENDALE PAIN TREATMENT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-15",
        "last_updated": "2021-06-22",
        "certification_date": "2021-06-22",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "SETH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-448-4841",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Glendale Medical Clinic LLC
• Glendale Medical Investors Limited Partnership
• Glendale Medical Supply
• Glendale Modern Dentistry, LLP
• Glendale Obstetrics and Gynecology PC
• Glendale Pediatrics LLC
• Glendale Redbird Co
• Glendale Redbird Co
• Glendale Regenerative Medicine
• Glendale Sports Massage LLC

• Pain Clinic/Center in Glendale, AZ
• Providers in Glendale, AZ by specialty
• Pain Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2021; 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.