Provider Demographics
NPI:1609173293
Name:EAST VALLEY PAIN PHYSICIANS, LLC
Entity Type:Organization
Organization Name:EAST VALLEY PAIN PHYSICIANS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:GOLLIHAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-486-1510
Mailing Address - Street 1:15262 N 75TH AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4763
Mailing Address - Country:US
Mailing Address - Phone:623-486-1510
Mailing Address - Fax:623-486-1529
Practice Address - Street 1:18610 E RITTENHOUSE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-4503
Practice Address - Country:US
Practice Address - Phone:623-486-1510
Practice Address - Fax:623-486-1529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty