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General NPI Number Information
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NPI Number | 1528367646
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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 | 03/16/2011
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Last Update Date | 03/16/2011
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Provider Practice Location Address
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Address Line | 114 S MOUNTAIN AVE
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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 | 928-333-0562
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Fax | 928-333-7157
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Provider Business Mailing Address
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Address Line | PO BOX 1917
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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 | 888-589-1943
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Authorized Official
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Title or Position | CEO/PROVIDER
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Name | JOHN C ALLEN
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Credential | CRNA
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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 | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | CRNA0632
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License Number State | AZ
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