Healthcare Provider Details

I. General information

NPI: 1356896138
Provider Name (Legal Business Name): NOVASPINE PAIN INSTITUTE, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2016
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3615 S ROME ST
GILBERT AZ
85297-7335
US

IV. Provider business mailing address

PO BOX 5068
SUN CITY WEST AZ
85376-5068
US

V. Phone/Fax

Practice location:
  • Phone: 480-771-4400
  • Fax: 480-771-4381
Mailing address:
  • Phone: 623-777-4747
  • Fax: 480-771-4381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number42990
License Number StateAZ

VIII. Authorized Official

Name: DR. DAVID K TOM
Title or Position: OWNER
Credential: MD
Phone: 480-372-8312