Provider Demographics
NPI:1275048316
Name:VALLEY OF THE SUN INSTITUTE FOR PAIN MANAGEMENT, PLLC
Entity Type:Organization
Organization Name:VALLEY OF THE SUN INSTITUTE FOR PAIN MANAGEMENT, PLLC
Other - Org Name:SEDONA PAIN AND REHABILITATION, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ESTELLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-955-1515
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:480-955-1515
Mailing Address - Fax:844-287-5554
Practice Address - Street 1:4921 E BELL RD STE 203
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-6002
Practice Address - Country:US
Practice Address - Phone:480-955-1515
Practice Address - Fax:844-287-5554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-12
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ449216Medicaid
AZ3223OtherSTATE LICENSE