Healthcare Provider Details

I. General information

NPI: 1477098432
Provider Name (Legal Business Name): PHOENIX SPINE SURGEONS, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2016
Last Update Date: 12/17/2023
Certification Date: 12/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 N LITCHFIELD RD SUITE 110
GOODYEAR AZ
85338
US

IV. Provider business mailing address

2525 E ARIZONA BILTMORE CIR SUITE D-142
PHOENIX AZ
85016-2146
US

V. Phone/Fax

Practice location:
  • Phone: 602-256-2525
  • Fax: 602-256-0795
Mailing address:
  • Phone: 602-256-2525
  • Fax: 602-256-0795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number22004
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number28519
License Number StateAZ

VIII. Authorized Official

Name: HANNAH LIEBERMAN
Title or Position: OPERATIONS DIRECTOR
Credential:
Phone: 602-256-2525