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ACTIVE LIFE PHYSICAL MEDICINE & PAIN CENTER PLLC NPI 1811130016


NPI Information

NPI: 1811130016
Provider Name: ACTIVE LIFE PHYSICAL MEDICINE & PAIN CENTER, PLLC
Classification: Physical Medicine & Rehabilitation - 2081P2900X
Entity Type: Organization

Specialization: Pain Medicine

CLIA Number: 03D1104696

Address:
3400 N. DYSART RD
BUILDING H; SUITE 131
AVONDALE, AZ
ZIP 85392
Phone: (623) 535-9777
Get Directions

ACTIVE LIFE PHYSICAL MEDICINE & PAIN CENTER, PLLC is a pain medicine physical medicine rehabilitation in Avondale, AZ. The provider is a physician who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic or cancer pain in both hospital and ambulatory settings. Patient care needs may also be coordinated with other specialists. ACTIVE LIFE PHYSICAL MEDICINE & PAIN CENTER, PLLC NPI is 1811130016. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

3400 N. DYSART RD
BUILDING H; SUITE 131
AVONDALE, AZ
ZIP 85392
Phone: (623) 535-9777
Fax: (623) 535-9778

The provider's authorized official is Wendi Lundquist .
The authorized official title is Owner/physician and has the following contact phone number (623) 535-9777.

The CLIA number assigned to this NPI record is 03D1104696 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/17/2009 and was last updated on 4/17/2009.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
12081P2900XPhysical Medicine & RehabilitationPain Medicine005097ARIZONAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.