Provider Demographics
NPI:1285812214
Name:ARIZONA PAIN MANAGEMENT AND REHABILITATION, PLLC
Entity type:Organization
Organization Name:ARIZONA PAIN MANAGEMENT AND REHABILITATION, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ESTELLE
Authorized Official - Middle Name:RHONDA
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-209-4554
Mailing Address - Street 1:13835 N TATUM BLVD STE 9326
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-0409
Mailing Address - Country:US
Mailing Address - Phone:480-209-4554
Mailing Address - Fax:844-287-5554
Practice Address - Street 1:13835 N TATUM BLVD STE 9326
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-0409
Practice Address - Country:US
Practice Address - Phone:480-209-4554
Practice Address - Fax:844-287-5554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3223208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ6172170001Medicare NSC