Healthcare Provider Details

I. General information

NPI: 1336552140
Provider Name (Legal Business Name): ARIZONA SPINE AND PAIN SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 W BELL RD STE F-101
GLENDALE AZ
85308
US

IV. Provider business mailing address

20280 N 59TH AVE STE 115-617
GLENDALE AZ
85308-6850
US

V. Phone/Fax

Practice location:
  • Phone: 602-795-8700
  • Fax: 602-795-8701
Mailing address:
  • Phone: 602-795-8700
  • Fax: 602-795-8701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PATRICK W HOGAN
Title or Position: MEMBER
Credential: DO
Phone: 602-795-8700