# CANYON PAIN SURGERY CENTER

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

## Provider details

- **NPI number:** 1972217180
- **Authorized official:** JODY SMITH (ADMINISTRATOR)
- **Authorized official phone:** (480) 565-5925

## Contact information

- **Practice address:** 4540 E BASELINE RD STE 117, MESA, AZ 85206-4617
- **Practice address phone:** (480) 561-0446
- **Practice address fax:** (480) 608-4762
- **Mailing address:** 4540 E BASELINE RD STE 117, MESA, AZ 85206-4617

## Taxonomy

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

## Other

- **Enumeration date:** 01/11/2023
- **Last updated:** 08/27/2024