Organization · NPI-2

Advanced Spine And Pain LLC

Physical Medicine & Rehabilitation, Pain Medicine · Mesa, AZ

NPI number1629679923

StatusActive

Last updated in NPPESJan 20, 2021

Details

NPI: 1629679923
Entity type: Organization (NPI-2)
Legal business name: Advanced Spine And Pain LLC
Organization subpart: No
Enumeration date: Nov 3, 2020
Certification date: Jan 20, 2021
Last updated: Jan 20, 2021

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
2081P2900X	Physical Medicine & Rehabilitation, Pain Medicine	–	–	Yes
208VP0000X		–	–
208VP0014X	Pain Medicine, Interventional Pain Medicine	–	–
207LP2900X	Anesthesiology, Pain Medicine	–	–
363A00000X	Physician Assistant	–	–
363L00000X	Nurse Practitioner	–	–

Practice location

4566 E Inverness Ave Ste 205
Mesa, AZ 85206-4634

Phone 480-640-0513

Mailing address

4566 E Inverness Ave Ste 205
Mesa, AZ 85206-4634

Phone 480-640-0513

Authorized official

Jarrett Michael Leathem
MD, Owner
8606702412

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