Organization
PROVIDENCE HEALTH GROUP LLC
Active
Organization
PROVIDENCE HEALTH GROUP LLC
Active
Other names
Genesis Wellness & Pain Management Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROGER B OLADE MD (OWNER/PHYSICIAN)
(404) 441-8752
Entity
Organization
Contact information
Practice address
300 W OSBORN RD STE 110, PHOENIX, AZ 85013-3922
(602) 265-1210
(602) 265-1222
Mailing address
300 W OSBORN RD STE 110, PHOENIX, AZ 85013-3922
(602) 265-1210
(602) 265-1222
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
208VP0000X
Pain Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
269526
—
AZ
Enumeration date
09/25/2007
Last updated
06/21/2011
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