# DESERT RIDGE PAIN FACILITY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760061758
- **Authorized official:** DR. MIKE CORMIER DC (MANAGING PARTNER)
- **Authorized official phone:** (480) 773-7662

## Contact information

- **Practice address:** 21001 N TATUM BLVD STE 78-1640, PHOENIX, AZ 85050-5244
- **Practice address phone:** (480) 773-7662
- **Mailing address:** 4300 N MILLER RD STE 240, SCOTTSDALE, AZ 85251-3639

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 04/06/2021
- **Last updated:** 04/06/2021