1710370960 NPI number — ARIZONA SPINE AND PAIN SPECIALISTS LLC

Table of content: (NPI 1710370960)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710370960 NPI number — ARIZONA SPINE AND PAIN SPECIALISTS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARIZONA SPINE AND PAIN SPECIALISTS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
AZ PAIN DOCTORS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710370960
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/05/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20280 N 59TH AVE
Provider Second Line Business Mailing Address:
STE 115-617
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85308-6850
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-795-8700
Provider Business Mailing Address Fax Number:
602-795-8701

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33747 N SCOTTSDALE RD
Provider Second Line Business Practice Location Address:
#135
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85266-1565
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-795-8700
Provider Business Practice Location Address Fax Number:
602-795-8701
Provider Enumeration Date:
03/12/2015

Additional Information

Authorized Official

Authorized Official Last Name:
HOGAN
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
W
Authorized Official Title or Position:
MEMBER/OWNER
Authorized Official Telephone Number:
602-795-8700

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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