Provider Demographics
NPI:1851742241
Name:VALLEY PAIN INTERVENTION CENTER
Entity Type:Organization
Organization Name:VALLEY PAIN INTERVENTION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHURCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-440-1985
Mailing Address - Street 1:2745 S ALMA SCHOOL RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-4405
Mailing Address - Country:US
Mailing Address - Phone:480-440-1985
Mailing Address - Fax:480-323-2323
Practice Address - Street 1:2745 S ALMA SCHOOL RD
Practice Address - Street 2:SUITE 2
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-4405
Practice Address - Country:US
Practice Address - Phone:480-440-1985
Practice Address - Fax:480-323-2323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMED6561261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical