Provider Demographics
NPI:1174700975
Name:PREMIER PAIN MANAGEMENT, LLC
Entity type:Organization
Organization Name:PREMIER PAIN MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:SIEFFERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:280-272-8944
Mailing Address - Street 1:4540 E BASELINE RD STE 105
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4616
Mailing Address - Country:US
Mailing Address - Phone:480-272-8944
Mailing Address - Fax:480-237-5682
Practice Address - Street 1:4540 E BASELINE RD STE 112
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4616
Practice Address - Country:US
Practice Address - Phone:480-272-8944
Practice Address - Fax:480-237-5682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC4333261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZOTC4913OtherOTC LICENSCE