Provider Demographics
NPI:1780913483
Name:PHOENICIAN PAIN & REHABILITATION CENTER
Entity type:Organization
Organization Name:PHOENICIAN PAIN & REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD.
Authorized Official - Prefix:
Authorized Official - First Name:SHIMUL
Authorized Official - Middle Name:B
Authorized Official - Last Name:SAHAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:480-398-1940
Mailing Address - Street 1:963 N MCQUEEN RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-8149
Mailing Address - Country:US
Mailing Address - Phone:480-398-1940
Mailing Address - Fax:480-782-1453
Practice Address - Street 1:963 N MCQUEEN RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-8149
Practice Address - Country:US
Practice Address - Phone:480-398-1940
Practice Address - Fax:480-782-1453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-09
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2081P2900X
AZ4954363AM0700X
AZ366712081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty