Healthcare Provider Details

I. General information

NPI: 1194973453
Provider Name (Legal Business Name): ARIZONA SPORTS AND SPINE PHYSICIANS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2008
Last Update Date: 08/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 W BELL RD # 101A
PHOENIX AZ
85053-3000
US

IV. Provider business mailing address

3033 W BELL RD # 101A
PHOENIX AZ
85053-3000
US

V. Phone/Fax

Practice location:
  • Phone: 602-375-3333
  • Fax: 602-375-0435
Mailing address:
  • Phone: 602-375-3333
  • Fax: 602-375-0435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number2333
License Number StateAZ

VIII. Authorized Official

Name: DR. JOHN STEVEN CHAROCHAK
Title or Position: MEDICAL DIRECTOR
Credential: D.O.
Phone: 602-375-3333