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General NPI Number Information
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NPI Number | 1023245461
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Entity Type | Organization
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Legal Business Name | SUNRISE ANESTHESIA & PAIN MANAGEMENT, PLLC
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Dates
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Enumeration Date | 06/11/2009
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Last Update Date | 09/13/2011
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Provider Practice Location Address
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Address Line | 114 S MOUNTAIN AVE WHITE MOUNTAIN SPECIALTY CLINIC
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City | SPRINGERVILLE
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State | AZ
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Zip | 85938-5104
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Country | US
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Telephone | 928-468-3132
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Fax | 888-717-3257
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Provider Business Mailing Address
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Address Line | PO BOX 1917 SUNRISE ANESTHESIA & PAIN MANAGEMENT, PLLC
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City | SPRINGERVILLE
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State | AZ
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Zip | 85938-1917
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Country | US
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Telephone | 928-468-3132
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Fax | 888-717-3257
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JOHN CLIFFORD ALLEN
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Credential | CRNA,MS
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Telephone | 928-468-3132
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | FELLOW, CPP #8633
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | CRNA0632
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | FELLOW,CPP #8633
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License Number State | AZ
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