Provider Demographics
NPI:1598392722
Name:PHOENIX PAIN MANAGEMENT LLC
Entity Type:Organization
Organization Name:PHOENIX PAIN MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LORRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TODD
Authorized Official - Suffix:
Authorized Official - Credentials:CPCS
Authorized Official - Phone:480-245-6008
Mailing Address - Street 1:34522 N SCOTTSDALE RD STE 120-138
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85266-1224
Mailing Address - Country:US
Mailing Address - Phone:480-563-6400
Mailing Address - Fax:
Practice Address - Street 1:34522 N SCOTTSDALE RD STE 120-138
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85266-1224
Practice Address - Country:US
Practice Address - Phone:480-563-6400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty