Organization · NPI-2

Advanced Spine And Pain LLC

Anesthesiology, Pain Medicine · Phoenix, AZ

NPI number1639951577
StatusActive
Last updated in NPPESOct 16, 2023

Details

NPI
1639951577
Entity type
Organization (NPI-2)
Legal business name
Advanced Spine And Pain LLC
Organization subpart
Yes
Enumeration date
Oct 16, 2023
Certification date
Oct 16, 2023
Last updated
Oct 16, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207LP2900X Anesthesiology, Pain Medicine––Yes
208VP0000X ––
208VP0014X Pain Medicine, Interventional Pain Medicine––

Practice location

333 W Thomas Rd Ste 204
Phoenix, AZ 85013-4425

Phone 480-573-0130 · Fax 480-573-0131

Mailing address

2525 W Greenway Rd Ste 125
Phoenix, AZ 85023-4226

Phone 480-573-0130 · Fax 480-573-0131

Authorized official

Jarrett Michael Leathem
Owner
8606702412

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