| Triad Pain Management Group, Pllc | |
|
5331 S Superstition Mountain Dr Ste C105 Gold Canyon AZ 85118-1921 | |
| (480) 413-0586 | |
| (480) 730-0487 |
| Full Name | Triad Pain Management Group, Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 5331 S Superstition Mountain Dr Ste C105, Gold Canyon, Arizona |
| Authorized Official Name and Position | John J Baca (CLINICAL DIRECTOR) |
| Authorized Official Contact | 4804130586 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Triad Pain Management Group, Pllc 5331 S Superstition Mountain Dr # C105 Gold Canyon AZ 85118-1921 Ph: (480) 413-0586 | Triad Pain Management Group, Pllc 5331 S Superstition Mountain Dr Ste C105 Gold Canyon AZ 85118-1921 Ph: (480) 413-0586 |
| NPI Number | 1477802536 |
|---|---|
| Provider Enumeration Date | 09/05/2012 |
| Last Update Date | 07/11/2023 |
| Medicare PECOS PAC ID | 8820242803 |
|---|---|
| Medicare Enrollment ID | O20130128000319 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477802536 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Tracy A Karas |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1952414625 PECOS PAC ID: 3476579772 Enrollment ID: I20051017000341 |
| Provider Name | Paul V Ledesma |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1629056981 PECOS PAC ID: 8921031071 Enrollment ID: I20091204000245 |
| Provider Name | Yolanda A Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417227695 PECOS PAC ID: 5092962415 Enrollment ID: I20120820000946 |
| Provider Name | Luke W Garcia |
|---|---|
| Provider Type | Practitioner - Pain Management |
| Provider Identifiers | NPI Number: 1265672067 PECOS PAC ID: 1456543412 Enrollment ID: I20130812000816 |
| Provider Name | Babara E Francis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437597655 PECOS PAC ID: 8921324021 Enrollment ID: I20150309001420 |
| Provider Name | Mary Elizabeth Braham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508176694 PECOS PAC ID: 9638497944 Enrollment ID: I20150417000595 |
| Provider Name | Kevin M Kerchansky |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407988785 PECOS PAC ID: 6103801717 Enrollment ID: I20210818001876 |
| Provider Name | Scott L Shindler |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1295742310 PECOS PAC ID: 4082517503 Enrollment ID: I20220608001962 |
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