Healthcare Provider Details

I. General information

NPI: 1639460025
Provider Name (Legal Business Name): PHOENIX SPINE CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2011
Last Update Date: 04/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19841 N 27TH AVE SUITE 300A
PHOENIX AZ
85027-4003
US

IV. Provider business mailing address

19841 N 27TH AVE SUITE 300A
PHOENIX AZ
85027-4003
US

V. Phone/Fax

Practice location:
  • Phone: 623-582-2010
  • Fax: 623-582-9323
Mailing address:
  • Phone: 623-582-2010
  • Fax: 623-582-9323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number29670
License Number StateAZ

VIII. Authorized Official

Name: DR. JOHN LOUIS BEGHIN
Title or Position: OWNER
Credential: MD
Phone: 623-582-2010