Provider Demographics
NPI:1154613586
Name:WHITE MOUNTAIN PAIN CLINIC, PLLC
Entity type:Organization
Organization Name:WHITE MOUNTAIN PAIN CLINIC, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CLIFFORD
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-696-6654
Mailing Address - Street 1:PO BOX 163
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:AZ
Mailing Address - Zip Code:85927-0163
Mailing Address - Country:US
Mailing Address - Phone:888-696-6654
Mailing Address - Fax:888-589-1943
Practice Address - Street 1:114 S MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:SPRINGERVILLE
Practice Address - State:AZ
Practice Address - Zip Code:85938-5104
Practice Address - Country:US
Practice Address - Phone:928-333-0562
Practice Address - Fax:928-333-7157
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUNRISE ANESTHESIA & PAIN MANAGEMENT, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain